Association of bone-related biomarkers with femoral neck bone strength

Abstract

Background Femoral neck fractures are the worst consequence of osteoporosis (OP), and its early prevention and treatment have become a public health problem. This study aims to investigate the relationship of bone-related biomarkers, femoral neck bone mineral density (BMD) and maximum load (Lmax), selecting the indicator which can reflect femoral neck bone loss and reduced bone strength. Methods A total of 108 patients were recruited from January 2017 to December 2019. Venous blood samples were collected from patients before total hip replacement, and femoral neck samples were collected during the surgery. Femoral neck BMD, femoral neck Lmax, bone-related markers (serum levels of bone turnover markers, protein expression of type I collagen (COL-I) and osteopontin (OPN) in femoral neck) were all measured and analyzed. Results The expression of COL-I in femoral neck were significantly decreased, whereas other markers were all significantly increased with the decreasing of femoral neck BMD and Lmax (P < 0.05). Among them, serum C-terminal telopeptide of type I collagen (CTX) levels and OPN expression of femoral neck were increased in osteopenia. In multiple linear regression analysis, CTX and OPN were both negatively correlated with femoral neck BMD and Lmax, and they were independent factors of femoral neck BMD and Lmax, whereas COL-I was independent factor affecting Lmax (P < 0.05). Besides, CTX was negatively correlated with COL-I (β = -0.275, P = 0.012) and positively correlated with OPN (β = 0.295, P = 0.003). Conclusions Compared with other indicators, serum CTX was more sensitive to differences in bone mass and bone strength of femoral neck, and could be considered as surrogate marker for OPN and COL-I.Early measurement of CTX could facilitate the diagnosis of osteopenia and provide a theoretical basis for delaying the occurrence of femoral neck OP and fragility fractures.

Dynamic Foot Pressure During Walking: A Potential Indicator of Bone Mineral Density

“…Consequently, researchers have been seeking alternative methods to diagnose osteoporosis and evaluate the risk of osteoporotic fractures without using a DXA examination. Recently, the FRAX (Fracture Risk Assessment Tool) score, which improves fracture prediction beyond that based on BMD measurement alone, has been widely used 20 . Other measures, such as hand grip strength and anthropometric measurements such as calf circumference, have also been introduced to diagnose BMD cost-effectively 16,21,22 .…”

Role of the Vitamin D Receptor (VDR) in the Pathogenesis of Osteoporosis: A Genetic, Epigenetic and Molecular Pilot Study

“…Our results showed that when VDR expression levels are downregulated, BMD and t -score decreased proportionally, associating the altered VDR expression pattern with a gradual stratification of bone densitometry, from the healthy to severe OP phenotype. A strength of our analysis is undoubtedly the presence of patients with severe OP, defined by the coexistence of the disease together with fragility fractures, particularly at the femur site [ 39 ]. Confirming the negative role played by the VDR decrease in OP pathogenesis and fracture risk, our results showed lower mean VDR expression levels in patients with femur fractures (OP_FF), which is considered the index fracture of OP disease.…”

“…Finally, we also correlated the methylation status of a CpG island located in the VDR promoter region with the VDR gene expression levels with no significant results. Several studies have highlighted the role of methylation in modulating VDR expression in different pathological contexts, mainly in autoimmune diseases, but none of these has concerned OP [ 39 ]. We focused our methylation analysis in a small region including six CG sites located in a VDR promoter CpG island (CGI 1062) already shown to functionally modulate VDR expression in a South African population [ 12 ].…”

The role of advanced glycation end products in fracture risk assessment in postmenopausal type 2 diabetic patients

“…Therefore, we suggest that the AGEs level as a correction factor that could improve the capacity of FRAX algorithm to predict fracture risk in T2D postmenopausal women. Serum bone turnover markers can be used to assess bone loss or formation more sensitive than BMD (53)(54)(55). Previous studies demonstrated reduced bone resorption and formation in T2D individuals (56-58), suggesting that hyperglycemia and AGEs crosslinking may impair the function of osteoblasts and osteoclasts, thereby inhibiting bone formation and promoting bone resorption.…”

“…Serum bone turnover markers can be used to assess bone loss or formation more sensitive than BMD ( 53 – 55 ). Previous studies demonstrated reduced bone resorption and formation in T2D individuals ( 56 – 58 ), suggesting that hyperglycemia and AGEs crosslinking may impair the function of osteoblasts and osteoclasts, thereby inhibiting bone formation and promoting bone resorption.…”