Measurement of bone metabolism markers and changes of bone mineral density in patients with bone and joint disease and fractures in perioperative period

doi:10.3969/j.issn.2095-4344.2016.35.018

Abstract

Abstract:

BACKGROUND: The bone mineral density is a static parameter that reflects the bone mass in a relatively long time. If you want to know the dynamic changes of bone metabolism, bone metabolism markers should be evaluated.

OBJECTIVE: To explore changes of bone metabolism markers and bone mineral density during perioperative period in patients with spine and joint degeneration and osteoporotic fractures.

METHODS: We retrieved PubMed and Wanfang database for articles published from 2005 to 2016. The key words were “bone metabolic markers, bone mineral density, serum, urine”. Twenty-nine articles were analyzed according to inclusion and exclusion criteria.

RESULTS AND CONCLUSION: At present, bone formation markers commonly used in clinic mainly included bone alkaline phosphatase, osteocalcin, procollagen type I N-terminal peptide, and procollagen type I C-terminal peptide. Bone resorption markers included tartrate resistant acid phosphatase, collagen type I N-terminal telopeptide, collagen type I C-terminal telopeptide, deoxidation pyridinoline, pyridinoline, and hydroxyproline. Bone mineral density had little change, and bone resorption markers were elevated in patients with spine and joint degeneration and osteoporotic fractures, indicating active resorption. Increased bone formation markers in patients with fracture during perioperative period suggested that new bone formed in perioperative period of fracture. In the perioperative period, bone formation markers reduced and bone formation was inhibited in patients with bone degeneration. Increased bone resorption is more obvious in perioperative period in patients with bone and joint disease and fractures, which probably further aggravated the degree of osteoporosis, and should be treated by regular anti-osteoporosis therapy.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Osteoporosis, Osteoporotic Fractures, Bone Density, Osteocalcin

CLC Number:

R318

Li Shi-hong, Liu Yang. Measurement of bone metabolism markers and changes of bone mineral density in patients with bone and joint disease and fractures in perioperative period[J]. Chinese Journal of Tissue Engineering Research, 2016, 20(35): 5290-5295.

Figures/Tables 3

2.2 骨折手术患者围术期骨代谢标志物及骨密度的变化骨折后局部骨量减少、骨转换增加，骨折患者围术期骨代谢的变化有其特点：①骨折后的疼痛及骨折围术期制动造成患者骨量的进一步丢失，使骨分解的生化标志物增加；②骨折同时启动骨愈合机制，因此在成骨活跃期血中骨形成标志物水平即会产生变化；③骨折围术期坏死骨的清除又使骨吸收性标志物水平变化。刘伟等[25]的研究纳入了40 例女性股骨转子间骨折患者，年龄61-93岁，均为跌倒所致骨折，排除了类风湿性炎节炎、强直性脊柱炎、骨肿瘤或或甲旁亢等影响骨代谢的疾病。在患者入院后次日及术后3个月抽血，测定Ⅰ型前胶原N末端前肽、Ⅰ型胶原C端交联肽、骨钙素、甲状旁腺激素、25-羟基维生素D等骨代谢指标，同时行髋关节骨密度、髋关节骨强度测定。结果发现，术后3个月时，骨形成标志物Ⅰ型前胶原N末端前肽较术前明显增高，甲状旁腺激素较术前降低，差异有显著性意义(P < 0.05)；而股骨颈、大转子及转子间的骨密度及骨强度与术前相比轻度下降，但差异无显著性意义(P > 0.05)。结果说明股骨转子间骨折围术期骨代谢旺盛，成骨加强，而甲状旁腺激素水平提示至术后3个月骨转换已经下降，但此时骨强度并无明显改善，因此需注意防护，加强抗骨质疏松治疗，避免发生再次骨折。张旭等[26]的临床回顾性研究与刘伟等相似，观察了47例女性股骨转子间骨折患者术前及术后3个月的血骨代谢指标变化，2个研究所得结果一致(图2)，治疗前和治疗后3个月比较，骨密度变化不大，Ⅰ型前胶原N末端前肽增高，甲状旁腺激素降低(P < 0.05)。石磊等[27]为了解骨科手术患者围手术期骨代谢变化特点，纳入了113例50岁以上的中老年骨科手术患者，其中49例是髋部骨折患者。此49例患者术后1周的骨吸收标志物Ⅰ型胶原交联C端肽为(0.66±0.40) μg/L，较术前(0.36±0.25) μg/L明显上升(P < 0.05)，提示骨折患者术后骨吸收加快；骨形成标志物骨钙素术后1周与术前比差异不显著[(13.94±7.33)，(14.43±7.84) μg/L，P > 0.05]，作者认为骨钙素未降低是骨折引起成骨活跃抵消了骨钙素降低的结果。"

2.3 骨关节病手术患者围术期骨代谢标志物及骨密度的变化脊柱和关节退变需手术治疗患者中骨质疏松、骨量减少的发生率较高，且体内维生素D缺乏情况较普遍，围手术期更容易出现骨量丢失、骨代谢紊乱。因此在骨关节退行性病手术患者围术期监测骨代谢标志物，有助于骨质疏松的防治及骨折风险预测。王旭等[28]收集139例脊柱退行性疾病手术治疗患者，分析骨代谢指标与骨密度之间的关系，并进一步探讨合并2型糖尿病对骨代谢和骨密度的影响。结果139例患者中骨量正常者仅为16.0%，87%体内维生素D缺乏(25-羟基维生素D<50 nmol/L)，说明此类患者普遍存在骨质疏松、骨量减少和维生素D缺乏的状况；多因素线性回归分析结果提示年龄、Ⅰ型前胶原N末端前肽是决定脊柱退行性疾病需手术患者骨密度变化的主要影响因素，这提示伴Ⅰ型前胶原N末端前肽升高的老龄患者，骨密度降低及骨质疏松的发病风险更大；糖尿病组患者的血Ⅰ型前胶原N末端前肽、β-胶原特殊序列及骨钙素水平均低于肥糖尿病组，说明合并2型糖尿病的患者处于一种低骨转换状态。石磊等[27]报告的113例50岁以上的中老年骨科手术患者中包括脊柱和关节退变者64例，应用电化学发光免疫方法测定术前及术后1周血骨钙素及Ⅰ型胶原交联C端肽水平。此64例患者术后1周的骨吸收标志物Ⅰ型胶原交联C端肽为(0.52±0.30) μg/L，较术前(0.39±0.32) μg/L明显上升(P < 0.05)，提示骨折患者术后骨吸收加快；骨形成标志物骨钙素术后1周低于术前[(12.37±8.66)，(16.70±11.45) μg/L，P < 0.05]，提示经手术干预后，骨形成过程受到抑制。在以上研究的基础上，石磊等[29]进一步观察了抗骨质疏松治疗对骨科手术患者围术期骨代谢的影响，他们纳入了90例老年骨科手术患者，其中脊柱和关节退变患者55例，骨折患者35例。90例患者被随机分为2组，对照组术后常规口服碳酸钙片和活性维生素D，治疗组在对照组基础上应用鲑鱼降钙素肌内注射或喷鼻，分别于术前、术后1周、术后3个月测定血骨钙素及β-胶原特殊序列水平，于术前、术后3个月采用DEXA双能X线骨密度仪测定患者腰椎及髋部骨密度。结果发现老年患者接受骨科手术前后骨代谢发生改变，手术后1周骨吸收过程活跃，骨形成过程受抑制；术后应用抗骨吸收类药物鲑鱼降钙素3个月抗骨质疏松治疗能有效抑制骨吸收，但对促进骨形成无明显影响(表3)。"

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