Elevated Creatine Kinase and Lactic Acid Dehydrogenase and Decreased Osteocalcin and Uncarboxylated Osteocalcin are Associated with Bone Stress Injuries in Young Female Athletes

Abstract

Stress fractures are a limitation for athletes not only in sports performance but in activities of daily living. Thus, preventing them is crucial. In female athletes, a triad of symptoms including low energy availability, functional hypothalamic amenorrhea and osteoporosis are considered risk factors for stress injuries, but biomarkers predictive of these outcomes are not available. Here, we evaluated 56 female university athletes and found that 13 had a history of stress bone injuries. Logistic regression analysis demonstrated that dysmenorrhea including amenorrhea, but not reduced food intake or body weight loss, was significantly associated with stress injuries. When we subdivided subjects into stress fracture and non-fracture groups, we found that serum levels of creatine kinase (CK) and lactic acid dehydrogenase (LDH) were significantly higher in the fracture group, while osteocalcin and uncarboxylated osteocalcin (ucOC), which are bone forming parameters, significantly decreased. Low vitamin D levels are associated with stress fractures, but serum vitamin D levels were higher in fracture compared to non-fracture subjects. We followed up 32 subjects for one year, and three exhibited new stress injuries during that period. A history of stress fracture history is significantly associated with experiencing a new stress fracture. We also found that subjects with new fracture performed significantly greater exercise activity than did non-fracture subjects. Taken together, our data indicate that increased serum CK and LDH and decreased serum osteocalcin and ucOC are biomarkers of stress injuries, and evaluating these markers along with dysmenorrhea, stress fracture history or high sports activity could predict future stress fractures in female athletes.

Hematological parameters in champion of Brazilian jiu‐jitsu paradesport: Case study

“…Creatine phosphokinase enzyme consists of a dimer composed of two subunits (B and M) and has three isoforms: CK-BB or CK-1 found mainly in the brain; CK-MB or CK-2, hybrid form, mainly in the myocardium and CK-MM or CK-3 mainly in skeletal muscle. The reaction catalyzed by CPK is to reversibly phosphorylate creatine at the expense of ATP with the creation of creatine phosphate, especially at rest, so that during muscle activity, the reaction occurs in reverse, aiming at the synthesis of ATP (Miyamoto et al, 2018). When the intensity of the exercise is adequate to the metabolic capacity of the muscle tissue, F I G U R E 6 Behavior of CPK and LDH parameters during the moments evaluated in the case study.…”

Targeting Bone Cells During Sexual Maturation Reveals Sexually Dimorphic Regulation of Endochondral Ossification

“…CPK is a muscular enzyme that can be used to determine muscle deterioration or reduced muscular activity, and changes in CPK could support recent findings that bone and muscle exhibit crosstalk via OCN and RANKL. (32) In particular, OCN has been characterized as a key regulator of muscle mass and exercise adaptation. (7,10,18,33) However, much of the prior research was performed with only in one sex, or the sex of the mice was not described, which may explain why the sexual dimorphism of OCN removal or OCN+ cell ablation was not described before.…”

“…( 32 ) In particular, OCN has been characterized as a key regulator of muscle mass and exercise adaptation. ( 7,10,18,33 ) However, much of the prior research was performed with only in one sex, or the sex of the mice was not described, which may explain why the sexual dimorphism of OCN removal or OCN+ cell ablation was not described before. Female DT‐treated mice also showed an elevation of the liver enzyme ALT.…”

Association of serum osteocalcin levels with glucose metabolism in trauma patients

“…An earlier study has shown decreased OC and increased creatine kinase levels in trauma and bone injury. [ 33 ] OC was directly correlated with urine albumin to creatinine ratio patients with type 2 diabetes. [ 34 ] Thus, potential changes in renal filtration caused by trauma, which can be assessed by changes in creatinine excretion, might be a plausible explanation.…”