Clinical Significance Of Bone Metabolic Markers In The Diagnosis And Treatment To Old Patients With Osteoporosis Fracture

Objective:To investigate the clinical significance about bone metabolic markers in the diagnosis and treament to old patients with osteoporotic fractures, to research its correlation with pathological histology and BMD changes, and to find a new reasonable treatment for old patients with osteoporotic fractures.Methods:1.100 old patients with osteoporosis(60 males and 40 females) were selected in orthopedics of the Fifth Hospital for Zun Yi Medical College from March 2009 to July 2010,38 patients without fracture (definded as group A),62 patients with fractures(definded as group B), all patients aged from 65 to 80 years old, the mean age was 76.4 years old. Old patients with osteoporotic fractures included 20 cases of spinal fractures,22 cases of hip fractures,14 cases of distal radius fractures and 6 cases of other fractures. diabetes, cancers and other conditions of bone disorders were excluded. DEXA was used for all the patients to detecte BMD, as well as all patients were measured four biochemical markers of bone through immunohistochemistry by blood tests, including TRACP 5b, BAP, N-MID OC and 25-OH-VD. According to the test values of TRACP 5b and BAP,5 patients of group B was extracted from each age group and divided into group C (7 males and 8 females) and group D (6 males and 9 females), aged between 65 to 79 years, TRACP 5b increased significantly in group C and BAP increased significantly in group D.2. Analyzed the correlation about BMD and four biochemical markers of bone test values with sex and age, compared to the difference about BMD and four biochemical markers of bone test values between group A and group B.3. The difference were compared to group C and group D about BMD and four biochemical markers of bone test values.4. During operation, the bone tissue of 8 patients in each group C and group D was taken for HE staining and electron microscopy scanning (SEM). In this way, the ratio of trabecular bone/bone area was calculated by the Mivnt image analysis system, osteoclast and osteoblast in bone were observed, so as the absorption lacuna and fold edge, etc.5. After operation, the antiresorptive drugs was used to patients of group C for 3 to 6 months, an average of 4.8 months. The bone peptide drug was used for the patients of group D to promote bone formation for 3 to 6 months, an average of 4.6 months, the two groups of patients were examined BMD and tested values of four biochemical markers after six months of anti-OP treatment. At last, the difference was analyzed by BMD and four biochemical markers test values in group C and group D.Results:1.The result of BMD was correlated significantly with sex and age of patients (P<0.05), four biochemical markers test values in group A and group B have a correlation with sex and age(P<0.05), the result of BMD and four biochemical markers test values of bone have no correlation between group A and group B (P>0.05).2. The result of BMD and four biochemical markers test values of bone had no differences between group C and group D before operation (P>0.05).3. By the examination of pathological bone fracture site in Group C and group D, it shows that the number of osteoblast reduce, but the number of osteoclast increase, and the number of osteoclast increase significantly in group C than in group D (P>0.05). There was a significant difference in trabecular bone/bone area ratio of group C and group D (P<0.05). By the electron microscope scanning, it shows that the osteoclasts of group C are more active than group D. The trabecular bone of group C is sloppy obvious and the number of absorbent cavity increase, and both of them are more than group D.4. The anti-OP drugs are used for Group C and group D after operation. After treatment, the two groups'BMD and four biochemical markers test values of bone are different between preoperative and after treatment in statistics(P<0.05).Conclusion:1.The detection of bone metabolic markers could help us to make it clearly that the main function of osteoblast reduce or osteoclast increase in bone tissue of patients and guide us to use anti-OP targeted drugs for the clinical, which can provide a new way for OP treatment and monitor its efficacy.2. Pathological histology can make us distinct the condition of osteoblasts, osteoclasts and trabecular bone in the site of bone fracture, and could offer a reference for choosing anti-OP drugs in clinical.3. After anti-OP targeted drugs therapy for the OP patients, the efficacy can be improved and the relative complications can be reduced.