Biochemical markers of bone turnover. A review.
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Adult↗
Biomedical subjects
K Akesson
Publications and source records attributed to K Akesson.
Serum osteocalcin increases during fracture healing in elderly women with hip fracture.
The purpose of this study was to define the bone metabolic properties during the postfracture period in elderly women with hip fracture. Osteocalcin (Oc), a marker of bone formation, was measured in 58 women with hip fracture (77 +/- 7 years) admitted to the hospital from their own homes. Serum samples were taken on average 5 h (range 1-21) from fracture and at follow-up, on average 4.6 months later. Comparison was made with 58 age-matched (79 +/- 5 years) women. Women with hip fracture had initially 30% lower Oc levels compared to the controls (p = 0.0001). The Oc level was independent of time elapsed from trauma, within 18 h, after which the level further decreased. At follow-up, Oc showed a 44% increase (p = 0.0001) and had reached the level of the controls, but not beyond it. A concomitant, but less marked increase was noted for alkaline phosphatase (ALP) (p = 0.0001). We conclude that although the bone formation, as assessed by Oc, is apparently lower in elderly women who sustain a hip fracture, the ability to induce a fracture response, with an increased bone turnover during fracture healing is intact. Subsequently, it is essential that a time perspective is applied, as the bone metabolic changes in patients having sustained a fracture are related to the time elapsed from fracture.
Aged↗
Micromotion of the acetabular component and periacetabular bone morphology.
The quality of the periacetabular bone might be an explanation for the increase in the rate of socket loosening seen radiographically in patients with rheumatoid arthritis as compared with patients with osteoarthrosis. Early implant micromotion, as measured by roentgen stereophotogrammetric analysis, is of predictive value with regard to long time retention. For uncemented porous sockets, the initial fixation might be decisive for the degree of bone ingrowth. Roentgen stereophotogrammetry was used to study cemented Charnley acetabular components in 32 hips with rheumatoid arthritis and 30 hips with osteoarthrosis, and uncemented Harris-Galante acetabular components in 19 hips with osteoarthrosis. Micromotions as long as 24 months after surgery were related to the periacetabular cancellous bone quality, as assessed by histomorphometric methods from samples taken during surgery. Acetabular components migrated more in hips with rheumatoid arthritis than in those with osteoarthrosis (p < 0.04). Hips with rheumatoid arthritis had approximately 4 times more nonmineralized bone than hips with osteoarthrosis (p < 0.0002). However, within each diagnostic group, no correlation was found between migration and the degree of mineralization (r < or = 0.24, p > or = 0.07). Migration of uncemented acetabular components did not correlate with the histomorphometric variables (r < or = 0.20, p > or = 0.42). Histomorphologic characteristics of the periacetabular trabecular bone do not seem to be of importance for acetabular component micromotion.
Acetabulum↗
Migration of the Charnley stem in rheumatoid arthritis and osteoarthritis. A roentgen stereophotogrammetric study.
Migration of 65 Charnley stems implanted with modern cementing techniques was studied by roentgen stereophotogrammetry. There were 25 patients with rheumatoid arthritis (RA) and 40 with osteoarthritis (OA) followed up for two years. In 43 cases a bone sample for histomorphometric analysis was obtained from the femur during the operation. In 22 cases the mean subsidence of the prosthetic head was 0.40 mm and in 20 the mean posterior migration was 1.25 mm. There was no difference in migration between the two diagnostic groups (p = 0.8) after adjusting for variations in gender, age and weight. Male gender was associated with increased subsidence (p = 0.006). Histological examination showed that the RA series had more osteoid surface (p = 0.04), but neither this, nor any of the other histomorphometric variables, influenced migration. These results suggest that, unlike the acetabular socket, the cemented Charnley femoral component is equally secure in osteoarthritis and in rheumatoid arthritis, and that its initial fixation is not influenced by the quality of the local cancellous bone. Our results provide data with which the early performance of new prosthetic designs and fixation methods can be compared.
Analysis of Variance↗
Energy-dispersive X-ray microanalysis of the bone mineral content in human trabecular bone: a comparison with ICPES and neutron activation analysis.
To evaluate the accuracy of bone mineral composition determination by electron microprobe analysis (EDX) the measurements have been compared to instrumental neutron activation analysis (INAA) and chemical analysis (ICPES). Bone specimens from five femoral heads were used. The trabecular content of calcium (Ca) and phosphorus (P) was analyzed by the three different methods. The EDX method allows for a microstructural analysis of intact, methylmetacrylate-embedded, undecalcified bone and the measuring points can thus be distinctly identified centrally in each trabecula. The analysis yielded 25.8 +/- 0.7 wt % Ca and 10.5 +/- 0.1 wt % P, compared with 22.2 +/- 0.5 and 23.0 +/- 1.0 wt % Ca, and 9.83 +/- 0.21 and 10.02 +/- 0.44 wt % P for INAA and ICPES, respectively. The EDX analysis was calibrated by consecutive measurements of a hard, pressed tablet of hydroxyapatit of known content. The mean Ca content deviated with -0.38 wt % from the given content and P with -0.89 wt %. We could not verify any particular interference from the embedding procedure, however, it is possible that the relatively lower P content still may reflect this. The magnesium (Mg) concentration was 0.31 +/- 0.02 wt % by EDX and 0.26 +/- 0.02 wt % by INAA. The EDX analytical method provides a useful tool for simultaneous elemental quantification in bone. It has the advantage of permitting the use of regular bone biopsy material and thus allowing for a unique microstructural evaluation of the degree of mineralization.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Periarticular bone in rheumatoid arthritis versus arthrosis. Histomorphometry in 103 hip biopsies.
Histomorphologic differences of the periarticular bone in rheumatoid arthritis (RA) and osteoarthrosis (OA) may be of importance for long-term prosthetic fixation. We have evaluated bone specimens, obtained during total hip replacement from an acetabular and a femoral biopsy site, in 42 RA-hips and 61 OA-hips. In both groups the bone turnover was increased in the acetabulum compared to that in the femur. In the acetabulums the total trabecular bone volume was equal, but osteoid volume, osteoid surface, resorptive surface, and the appositional rate were increased in RA. On the femoral side, only the osteoid volume was higher in RA. The increased bone turnover with a greater amount of unmineralized tissue, as well as resorptive activity in the acetabulum, may be of importance for the higher rate of acetabular component migration and loosening after total hip replacement in RA.
Acetabulum↗
Circulating levels of vitamins K1 and K2 decreased in elderly women with hip fracture.
We measured the serum levels of phylloquinone (vitamin K1) and of the menaquinones, MK-7 and MK-8, in a group of 51 women with a mean age of 81 years who were studied within a few hours after a hip fracture. A group of 38 healthy age-matched women randomly chosen from the same population served as controls. Patients with hip fracture had a marked reduction in serum vitamin K1 (336 +/- 302 versus 585 +/- 490 pg/ml, p < 0.01), MK-7 (120 +/- 84 versus 226 +/- 178 pg/ml, p < 0.001), and MK-8 (89 +/- 113 versus 161 +/- 145 pg/ml, p < 0.01), and a large number had undetectable levels, especially of MK-8. Vitamin K levels were not correlated with the time elapsed after fracture or with serum cortisol or other biochemical variables. These data suggest that patients with hip fracture have vitamin K deficiency, an abnormality that could affect bone metabolism through an impairment of the gamma carboxylation of the gla-containing proteins of bone.
Aged↗
Impairment of bone turnover in elderly women with hip fracture.
Hip fracture is one of the most severe consequences of osteoporosis affecting aged women. However, abnormalities of bone turnover responsible for bone loss in this condition have not been clearly defined. To further evaluate the bone metabolic status of women sustaining hip fracture, we have prospectively measured serum osteocalcin as a marker of bone formation and urinary excretion of pyridinoline (Pyr) and deoxypyridinoline (D-pyr) cross-links as markers of bone collagen degradation in 174 independently living women (80 +/- 8 years) within a few hours after a hip fracture. Comparison was made with 77 age-matched controls (80 +/- 5 years) and 17 premenopausal women (39 +/- 3 years). In addition 15 of the patients were followed with daily measurements during the first postoperative week. At the time of admission osteocalcin was 20% lower in the fractured women compared to the elderly controls (7.6 +/- 3.8 vs. 9.5 +/- 4.5 ng/ml, P = 0.001). Pyr and D-pyr were 36% and 40% higher, respectively (P = 0.0001), than in elderly controls and 85% and 76% higher than in premenopausal controls (P = 0.0001). Serum osteocalcin did not correlate with the cortisol level measured at the same time (r = 0.03, ns), nor with serum albumin and creatinine. Serum osteocalcin remained unchanged within 18 hours after fracture, whereafter it progressively decreased until the third postoperative day. No correlation was noted between the excretion of pyridinoline cross-links and the time elapsed from fracture.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Serum osteocalcin and fracture susceptibility in elderly women.
The purpose of this investigation was to evaluate the bone turnover by using bone metabolic markers in relation to previous fracture history and independent of bone mass. Patients and controls were recruited from a population-based study of 193 women, all living in the same city and aged 60, 70, and 80 years. The bone mineral content (BMC) was measured bilaterally in the distal forearm by single-photon absorptiometry (SPA). At the same time, serum samples were obtained for biochemical analysis. Of the 193 women, we identified 26 with at least one major fracture during the past few years. Each of these 26 women with a certified recent previous fracture was individually matched with a woman from the same study group of equal BMC and age but without a fracture history. In the two groups, the serum samples were analyzed for osteocalcin, C-terminal procollagen peptide (P1CP), alkaline phosphatase, bone-specific alkaline phosphatase, calcium, phosphate, and albumin. The serum concentration of osteocalcin was 20% lower in the women with a previous fracture than in the controls (P = 0.03). The other markers of bone formation gave similar values in the two groups. There was a significant correlation between the osteocalcin and P1CP concentrations (P = 0.001). Our findings indicate that the susceptibility to fractures independent of factors such as age and BMC may be related to a decreased bone turnover.
Absorptiometry, Photon↗
Periarticular bone mineral content in rheumatoid arthritis and arthrosis of the hip. Dual photon X-ray absorptiometry in 53 cases.
The bone mineral content (BMC) was determined by dual photon X-ray absorptiometry prior to hip replacement in 22 patients with rheumatoid arthritis and 31 with arthrosis. Compared with the arthrosis patients, the rheumatoids had approximately 20 percent lower bone mineral content in the proximal femur, the lumbar spine, and in the innominate bone superior to the acetabulum.
Absorptiometry, Photon↗
Bone mineral normative data in Malmö, Sweden. Comparison with reference data and hip fracture incidence in other ethnic groups.
The bone mineral mass was measured in 324 residents of the city of Malmö, Sweden, by dual energy roentgen absorptiometry (DEXA) using the Lunar DPX equipment--total body, hip, and lumbar vertebrae. The bone mineral content of the wrist was also measured with single photon absorptiometry (SPA) in 88 of the individuals. Weight, height, and vertebral height, as well as body fat, lean body mass, menarcheal age, menopausal age, and hand grip strength were determined. Measurements were compared with reference bone mineral content values from the United States, Japan, and France--also hip fracture incidence was compared. All bone mineral values decreased with age. A good correlation was found between the DEXA technique of total body bone mineral and the forearm SPA values. The bone mineral content was correlated with lean body mass and weight. The Malmö bone mineral content was on the same level as in the United States, but higher than in Japan and France. The comparatively high risk of fragility fractures in the Scandinavian countries compared with most other settings cannot be explained by low bone mass.
Adult↗
Earlier wrist fracture: a confounding factor in distal forearm bone screening.
Thirty-six women aged 60, 70 or 80 years who had fractured one of their distal radii (Colles' fracture) 0 to 35 (median 10) years earlier were examined in this population-based study. Single photon measurements (SPA) were performed on both arms 1 cm and 6 cm proximal to the styloid process of the ulna. All women were questioned about earlier wrist fractures and which, if any, side had been affected. Information about the type and site of the fracture was also gathered from the hospital records. The bone mineral content (BMC) was found to be increased by almost 20% in the once-fractured radius at the distal measuring site (1 cm) when compared with the unaffected side. This difference did not seem to diminish with time. At the proximal measuring site there was no difference between the once-fractured and the non-fractured side. There was a progressive loss of bone mineral in the once-fractured arm during the first years after the fracture however. This appeared to be reversed after about 10 years to a relative gain, even though the correlation was weak. Six of the 36 women could not remember which side had been fractured and five could not remember having had such a fracture at all. Determination of osteoporosis by measuring forearm BMC with single photon densitometry is therefore of limited value in some women of the oldest age groups.
Age Factors↗