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A decrease in serum 1,25(OH)2D after elective hip replacement and during bone healing is associated with changes in serum iron and plasma FGF23

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Abstract

Objective

Although calcitriol is essential for bone healing, its serum concentrations are low after hip surgery, and they continue to decline during bone healing. This study aimed to test the hypothesis of an association of changes in calcitriol production with the status of fibroblast growth factor 23 (FGF23) and iron deficiency after elective hip replacement for coxarthrosis.

Methods

In this prospective study, we measured the biomarkers of 17 patients undergoing elective hip replacement on admission, on the first day after surgery, and at the regular check-up after 48 ± 8 days. The serum concentrations of 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D, transferrin, ferritin, parathyroid hormone, intact plasma FGF23 (iFGF23) and C-terminal FGF23 (cFGF23) were determined.

Results

In our patients who underwent elective hip replacement, significant correlations existed between the percent change in the conversion rate of 25(OH)D to 1,25(OH)2D, plasma intact to C-terminal FGF23 ratio, and serum iron.

Conclusions

The production of calcitriol is compromised after elective hip replacement surgery, leading to reduced levels of active vitamin D in the serum. Significant correlations between the percent change in the conversion rate of 25(OH)D to 1,25(OH)2D, plasma intact to C-terminal FGF23 ratio, and serum iron on the first day as well as 7 weeks after surgery could inspire future studies to determine whether and how calcitriol deficiency should be corrected, especially in fracture cases.

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Acknowledgements

The authors would like to thank Alena Adamová, Ludmila Hauptvoglová and Tereza Malá and for their excellent technical assistance in this project, and Xiao Svec for proofreading the manuscript.

Funding

This investigation was supported by the project for conceptual development of research organization 00023728 (Institute of Rheumatology, Prague, Czech Republic).

Author information

Authors and Affiliations

  1. Orthopedic Department, Bulovka Hospital, Prague, Czech Republic

    J. Vaculik & M. Bobelyak

  2. Institute of Rheumatology, Prague, Czech Republic

    L. Wenchich, K. Pavelka & J. J. Stepan

  3. Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic

    K. Pavelka & J. J. Stepan

  4. Third Faculty of Medicine, Charles University, Prague, Czech Republic

    J. Vaculik & M. Bobelyak

  5. Orthopedic Department, First Faculty of Medicine, Charles University, Prague, Czech Republic

    J. Vaculik

Authors
  1. J. Vaculik
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  4. K. Pavelka
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Contributions

All authors participated in drafting or revising this manuscript. All authors had access to the data, and have read and accepted the final version of the manuscript for submission. All authors take responsibility for the integrity of the data and the accuracy of the data analysis. JV and MB performed clinical assessment, followed-up with patients, and interpreted the data. LW. contributed to biochemical determination and data analysis. KP performed critical revisions of the manuscript. JJS designed this study, performed data analysis and prepared the manuscript.

Corresponding author

Correspondence to J. J. Stepan.

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Conflict of interest

The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of this study.

Ethical approval

All procedures performed in the present study involving humans were in accordance with the institutional research committee and with the principles of the Declaration of Helsinki. The study was approved by the Institutional Review Board of the Bulovka Hospital, Prague, Czech Republic.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Vaculik, J., Wenchich, L., Bobelyak, M. et al. A decrease in serum 1,25(OH)2D after elective hip replacement and during bone healing is associated with changes in serum iron and plasma FGF23. J Endocrinol Invest 45, 1039–1044 (2022). https://doi.org/10.1007/s40618-022-01746-1

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  • DOI: https://doi.org/10.1007/s40618-022-01746-1

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