二次骨折风险评价：老年女性髋部骨折后6-12个月骨密度及骨代谢变化

背景：国内外文献中关于骨折后骨代谢指标及骨密度变化量的前瞻性研究在20世纪60年代就开始有文献报道,但主要集中于胫腓骨和踝关节骨折患者,且样本量较低。 目的：观察老年女性髋部骨折愈合后(伤后6-12个月)骨密度及骨代谢指标的变化情况,并分析其相关性。 方法：选择2011年5月至2013年7月北京航天总医院骨科收治的老年女性髋部骨折患者48例,制定随访标准进行L1-4、患侧、健侧髋部骨密度测量及骨代谢指标骨碱性磷酸酶、骨钙素、Ⅰ型胶原交联C末端肽、血清抗酒石酸酸性磷酸酶5b水平测定,并行骨折愈合后患侧全髋部骨密度与血清骨代谢指标的多元线性回归分析。 结果与结论：患者骨折愈合后,患髋及腰椎骨密度显著低于基线值,健髋部位骨密度与基线值差异无显著性意义。患者在伤后6个月,即骨折完全愈合时,骨代谢指标骨碱性磷酸酶、骨钙素、Ⅰ型胶原交联C末端肽、血清抗酒石酸酸性磷酸酶5b水平均显著高于基线值(P < 0.05)。患者在伤后12个月,即骨折完全愈合6个月,骨钙素水平显著高于基线值,其余骨代谢指标与基线值差异无显著性意义。骨折达到临床及影像学愈合后,血清骨钙素水平的改变量与患髋骨密度改变量的偏回归系数最大。提示骨折达到临床愈合后,骨钙素血清水平对于评估骨密度回升速度具有较高价值。骨折愈合后监测相应的骨代谢指标可以提高判断骨密度变化的准确性,以降低罹患二次骨折的风险。 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程全文链接：

Secondary fracture risk assessment: Bone mineral density and bone metabolism of elderly women within 6-12 months after hip fractures

BACKGROUND: Prospective studies concerning bone metabolism and bone mineral density variation after fractures have been reported from the 1960s, but these studies are mainly focused on tibia and fibula and ankle fractures in patients with low sample size. OBJECTIVE: To observe the changes in bone mineral density and bone metabolism indexes in elderly women within 6 to 12 months after hip fractures, and to analyze the correlation. METHODS:We selected 48 elderly women with hip fractures admitted in the Department of Orthopedics, Beijing Aerospace General Hospital in China from May 2011 to July 2013. Standards for follow-up were developed to measure the bone mineral density and bone metabolism indexes in the L1-4 spinal segments and both sides of the hip. The bone metabolism indexes included bone alkaline phosphatase, osteocalcin, cross-linked C-terminal peptide of collagen I, and serum tartrate-resistant acid phosphatase 5b levels. Multiple linear regression analysis was performed based on measurements of bone mineral density and bone metabolism indexes after fracture healing.  RESULTS AND CONCLUSION: After fracture healing, bone mineral density of the fractured hip and lumbar vertebra was significantly lower than the baseline value. There was no statistical difference in bone mineral density between the healthy hip and the baseline value. At 6 months after fractures, bone alkaline phosphatase, osteocalcin, cross-linked C-terminal peptide of collagen I, and serum tartrate-resistant acid phosphatase 5b levels were significantly higher than the baseline values. At 12 months after fractures, osteocalcin level was significantly higher than the baseline value, while other indexes of bone metabolism measurements showed no statistical difference from the baseline values. When healing of hip fractures met the clinical and radiographic standards, the partial regression coefficient of delta-Z score reached peak in the changes of serum osteocalcin and bone mineral density of the fractured hip. Under clinical healing of fractures, serum osteocalcin level exhibits a higher value for the assessment of recovery speed of bone mineral density. Monitoring corresponding bone metabolism indexes after fracture healing can improve the accuracy of judging bone mineral density changes to reduce the risk of secondary fractures.