Chinese Journal of Tissue Engineering Research ›› 2021, Vol. 25 ›› Issue (5): 657-661.doi: 10.3969/j.issn.2095-4344.2994

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Bone turnover characteristics in patients with alcohol-induced osteonecrosis of the femoral head

Zheng Xiaolong1, He Xiaoming1, Gong Shuidi1, Pang Fengxiang1, Yang Fan1, He Wei2, Liu Shaojun3, 4, Wei Qiushi2, 5   

  1. 1First Clinical School of Medicine, Guangzhou University of Chinese Medicine, Guangdong Province, China;2Department of Arthritis, the Third Affiliated Hospital of Guangzhou University of Chinese Medicine;3Department of Orthopedics, First Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangdong Province, China;4Hip Research Center, Guangzhou University of Chinese Medicine;5Institute of Orthopedics, Guangzhou University of Chinese Medicine, Guangdong Province, China

  • Received:2019-12-09 Revised:2019-12-12 Accepted:2020-04-11 Online:2021-02-18 Published:2020-11-27
  • Contact: Wei Qiushi, MD, Associate chief physician, Department of Arthritis, the Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510378, Guangdong Province, China; Institute of Orthopedics, Guangzhou University of Chinese Medicine, Guangzhou 510378, Guangdong Province, China
  • About author:Zheng Xiaolong, Master candidate, Physician, First Clinical School of Medicine, Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China
  • Supported by:
    the National Natural Science Foundation of China (General Projects), No. 81473697, 81873327; Guangdong Provincial Science and Technology Department-Guangdong Academy of Chinese Medicine Joint Research Special Project, No. 2016A020226028; Guangdong Natural Science Foundation, No. 2017A030313698

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Abstract: BACKGROUND: The pathological changes of alcohol-induced osteonecrosis of the femoral head (ONFH) are the result of a combination of various factors, and its specific pathogenesis is inconclusive. Related studies have shown abnormal bone metabolism in patients with avascular necrosis of the femoral head.
OBJECTIVE: To explore the bone turnover markers in patients with alcohol-induced ONFH and to explore the relationship between different stages of ONFH and bone metabolism.
METHODS: This study retrospectively selected 193 male patients with alcohol-induced ONFH (necrosis group), including 35 cases of ARCO stage II, 131 cases of ARCO stage III and 27 cases of ARCO stage IV. Among them, there were 65 cases of a little drinking of alcohol 52 cases of moderate drinking, and 76 cases of heavy drinking. Another 182 healthy males undergoing physical examination with no history of drinking were taken as control group. The bone turnover markers [procollagen type 1 N-terminal propeptide (P1NP), C-terminal cross-linked telopeptides of type 1 collagen (β-CTX), molecular fragment of N-terminal osteocalcin (N-MID) and 25 hydroxyvitamin D (25OHD)] and biochemical indexes were tested and compared between two groups, followed by logistic regression analysis and correlation analysis. The study protocol was performed in line with the relevant ethic requirements of the First Affiliated Hospital of Guangzhou University of Chinese Medicine. All participants in the trial had been fully informed of the trial process.
RESULTS AND CONCLUSION: In the necrosis group, P1NP, β-CTX, N-MID, 25OHD, serum calcium, uric acid, alkaline phosphatase, serum phosphorus levels were significantly higher than that of the control group (P < 0.05), and apolipoprotein A1 and high-density lipoprotein levels in the necrosis group were significantly lower than those in the control group (P < 0.05). Compared with patients with low level of alcohol, β-CTX and N-MID levels were significantly reduced in the patients with heavy drinking (P < 0.05). The P1NP level of patients with ARCO stage IV was significantly higher than that of patients with ARCO stage II and III (P < 0.05), and the β-CTX level of patients with ARCO stage IV was significantly higher than that of patients with ARCO stage III (P < 0.05). The correlation analysis results showed that alcohol intake levels were negatively correlated with β-CTX, alkaline phosphatase level was positively correlated with P1NP and β-CTX, and 25OHD was negatively correlated with low-density lipoprotein. Logistic regression analysis results showed that: P1NP (odds ratio=0.984, P=0.004), β-CTX (odds ratio=0.325, P=0.043), and high-density lipoprotein (odds ratio=2.622, P=0.014). To conclude, male patients with alcohol-induced ONFH have active bone formation and bone resorption, and obvious abnormalities in lipid metabolism. The progression of alcohol-induced ONFH can be predicted by these bone turnover markers.

Key words: bone, osteonecrosis of the femoral head, alcohol-induced osteonecrosis of the femoral head, bone turnover markers, bone metabolism, bone resorption, bone formation, protein

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