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Parameters of bone health and fracture risk in older female fall victims: what do they tell us?

Sturz und Fraktur – Gibt es aussagekräftige serologische „Knochenparameter“ bezüglich des Frakturrisikos bei älteren Patientinnen?

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Abstract

Introduction

A common and severe osteoporotic type fracture in older women is a hip fracture. It is not clear whether bone turnover parameters measured in blood can be a useful tool to predict fracture risk in older persons. The aim of the current study was to assess the association between serum vitamin D (25OHD) levels, parathyroid hormone (PTH), total osteocalcin, carboxy-terminal collagen crosslinks (CTX) and hip fractures in older fallers.

Material and methods

A single centre, prospective cohort study of bone parameters was carried out in 400 female patients aged > 70 years including 200 with a hip fracture and 200 without fractures, admitted after a fall between January 2005 and December 2007.

Results

Serum total osteocalcin levels were significantly lower in the fracture group compared to the non-fracture group (20.4 ng/ml vs 26.1 ng/ml, respectively, p = 0.01). This finding remained significant after exclusion of the patients on bisphosphonates (p = 0.003). There were no significant differences in 25OHD, PTH or CTX levels between the two groups.

Conclusion

In the current study there was an association between the presence of a hip fracture and lower total serum osteocalcin concentrations. This could be indicative of low bone turnover osteoporosis in these women. An association for other bone turnover markers was lacking.

Zusammenfassung

Hintergrund und Ziel

Die hüftnahe Fraktur ist eine häufige und folgenschwere osteoporotische Fraktur bei älteren Frauen nach einem Sturz. Es ist bisher nicht geklärt, ob im Blut gemessene Knochenumsatz-Parameter als nützliches Werkzeug zur Voraussage des Frakturrisikos bei älteren Personen verwendet werden können. Ziel dieser Studie war es, herauszufinden ob eine Assoziation zwischen Serum-Vitamin-D-Spiegel (25OHD), Parathormon (PTH), Gesamtosteocalcin, carboxy-terminalen Kollagen-Crosslinks (CTX) und Hüftfrakturen bei älteren Sturzpatientinnen besteht.

Patienten

Zwischen Januar 2005 und Dezember 2007 wurde eine monozentrische prospektive Kohortenstudie mit 400 über 70-jährigen Patientinnen, die nach einem Sturz in das Unfallkrankenhaus Wien-Meidling aufgenommen wurden, durchgeführt. 200 Patientinnen hatten eine Hüftfraktur und 200 hatten andere Verletzungen (keine Frakturen).

Ergebnis

In der Frakturgruppe waren die Serum-Gesamtosteocalcin-Spiegel signifikant niedriger als in der Nicht-Frakturgruppe (p = 0,01). Nach Ausschluss der mit Bisphosphonaten behandelten Patientinnen blieb der Unterschied signifikant. Bezüglich 25OHD, PTH und CTX fanden sich keine statistisch signifikanten Unterschiede in beiden Gruppen.

Schlussfolgerung

In der vorliegenden Studie konnte eine Assoziation zwischen dem Auftreten einer Hüftfraktur und einem niedrigen Serum-Gesamtosteocalcin-Spiegel bei älteren Sturzpatientinnen nachgewiesen werden. Dies könnte ein Indiz für das Vorliegen einer Osteoporose mit niedrigem Knochenumsatz (low bone turnover osteoporosis) bei den Patientinnen mit Hüftfrakturen sein. Bei den anderen Knochenumsatz-Parametern fand sich keine derartige Assoziation.

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Authors and Affiliations

  1. Trauma Hospital Meidling, Kundratstraße 37, 1120, Vienna, Austria

    Heinrich W. Thaler MD

  2. Section of Geriatric Medicine, Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands

    Christian Oudshoorn MD &  Tischa J.M. van der Cammen MD, PhD

  3. Department of Surgery, Reinier de Graaf Group, Delft, The Netherlands

    Klaas A. Hartholt MD, PhD

  4. Department of Medicine, Brighton and Sussex Medical School, Brighton, UK

    Tischa J.M. van der Cammen MD, PhD

  5. Faculty of Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands

    Tischa J.M. van der Cammen MD, PhD

Authors
  1. Heinrich W. Thaler MD
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  2. Christian Oudshoorn MD
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  3. Klaas A. Hartholt MD, PhD
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  4. Tischa J.M. van der Cammen MD, PhD
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Correspondence to Heinrich W. Thaler MD.

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Conflict of interest

Heinrich W. Thaler, Christian Oudshoorn, Klaas A. Hartholt and Tischa J.M. van der Cammen state there are no conflicts of interest.

All studies described in the present manuscript were carried out with the approval of the responsible ethicscommittee and in accordance with national law and the Helsinki Declaration of 1975 (in its current, revised form). Informed consent was obtained from all patients included in the studies.

Additional information

Heinrich W. Thaler and Christian Oudshoorn contributed equally to this article.

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Thaler, H., Oudshoorn, C., Hartholt, K. et al. Parameters of bone health and fracture risk in older female fall victims: what do they tell us?. Z Gerontol Geriat 48, 539–542 (2015). https://doi.org/10.1007/s00391-014-0843-2

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  • DOI: https://doi.org/10.1007/s00391-014-0843-2

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