Fibroblast Growth Factor-23, Sclerostin, and Bone Microarchitecture in Patients With Osteoporotic Fractures of the Proximal Femur: A Cross-sectional Study

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• 作者：Philipp K.E. Herlyn¹ ; ^a ; Norina Cornelius¹ ; ^a ; Dieter Haffner² ; ^b ; Franziska Zaage² ; Cornelius Kasch³ ; Hans-Christof Schober⁴ ; Thomas Mittlmeier¹ ; Dagmar-C. Fischer² ; ^{dagmar-christiane.fischer@med.uni-rostock.de" class="auth_mail" title="E-mail the corresponding author}
• 关键词：μCT ; DXA ; osteoporosis ; proximal femur fracture
• 刊名：Journal of Clinical Densitometry
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：19
• 期：2
• 页码：192-201
• 全文大小：1006 K

文摘

This cross-sectional observational cohort study was designed to simultaneously investigate bone microarchitecture and serum markers of bone metabolism in elderly osteoporotic patients experiencing a trochanteric or femoral neck fracture. Special emphasis was put on renal function, sclerostin and fibroblast growth factor-23 (FGF-23). Eighty-two patients (median age: 84 years; 49 trochanteric fractures) scheduled for emergency surgery due to an osteoporotic fracture participated. Bone specimens for ex vivo microcomputed X-ray tomography were sampled during surgery. Blood samples for laboratory workup were collected before surgery (t₀) and 1 day afterward (t₁). Fifty-eight patients consented to dual-energy X-ray absorptiometry scanning of the lumbar spine and/or contralateral femoral neck after recovery during the in-patient stay. Samples were grouped according to the site of fracture. Regression coefficients were controlled for age and/or estimated glomerular filtration rate (eGFR), if appropriate. Patients experiencing a femoral neck fracture presented with better preserved renal function (eGFR) and lower C-terminal fragment of fibroblast growth factor-23 (cFGF-23) concentrations compared to those with trochanteric fractures. By contrast, serum sclerostin was similar at both time points and did not differ between groups. Age-adjusted correlation analysis revealed negative associations between eGFR and cFGF-23 determined at t₁ (R = −0.34; p < 0.05) as well as between eGFR and sclerostin levels at t₀ (R = −0.45; p < 0.05) in patients with trochanteric and femoral neck fractures, respectively. Our study provides evidence that not only an age-related decline of renal function but also the type of skeletal injury may contribute to the circulating concentrations of cFGF-23.