| BackgroundOsteoporosis-related fractures tend to occur in elderly women.Due to the fragility of the bone,osteoporosis-related fractures can occur in any part of the body,but usually occur in the proximal femur,distal radius,proximal humerus and vertebrae.Hip fragility fractures(including femoral neck fractures,femoral intertrochanteric fractures,etc.)are important components of osteoporotic bone.Fragility fracture of the hip has brought serious economic burden and adverse effects to patients,families and society,and has become an important factor threatening the life and quality of life of middle-aged and elderly people.Singh index was first proposed by Singh in 1978 to measure the mechanical strength of bone by measuring the morphology of trabecular bone in proximal femur with the help of X-ray.At present,although bone mineral density measurement can accurately measure the bone mass of the measured site,it cannot show the bone micro structure of the measured site,and its sensitivity in judging bone strength and predicting potential fracture risk is limited.Therefore,it has become a common method for orthopedic clinicians to evaluate the quality of the measured site by measuring the micro structure such as the quality and quantity of bone trabeculae combined with Singh index.However,Singh index is limited because it needs subjective evaluation by clinicians,and the quality of X-ray films also has a certain impact on the reading of X-ray films.Bone remodeling is a dynamic process that reflects the interplay between bone formation by osteoblasts and bone resorption by osteoclasts.During bone resorption,the activity of osteoclasts leads to the release of degradation products of type I collagen,a process typically mediated by specific enzymes such as tartrate-resistant acid phosphatase 5b(TRAP-5b),a bone-specific marker for osteoclast activity.In healthy bone,the resorption cavity created by osteoclasts is filled with new bone matrix by active osteoblasts,and the molecular marker for bone formation,osteocalcin(OC),secreted by active osteoblasts,is part of the process of binding to mineralized bone matrix.Another typical biomarker for bone formation is the N-terminal propeptide of type I collagen(P1NP),which is a byproduct of collagen synthesis.Specifically,after the synthesis of new type I collagen in osteoblasts,P1NP is cleaved from the type I procollagen by proteinases located outside osteoblasts.Adequate intake of vitamin D and calcium can significantly reduce the risk of non-spine fractures,especially for those who are deficient in vitamin D.Numerous clinical trials have shown that calcium and/or vitamin D supplementation helps prevent bone loss and regulate levels of bone remodeling biomarkers.Part 1 Correlation analysis of Singh index and bone metabolism biochemical indexes in middleaged and elderly patients with fragility fracture of hipObjective To investigate the correlation between the Singh index,a measure of proximal femoral bone trabecular pattern,and serum biochemical markers of bone metabolism in elderly patients with hip fragility fractures.Methods A retrospective analysis was conducted on data from 71 elderly patients with hip fragility fractures(including femoral neck fractures and intertrochanteric fractures)admitted to the Joint Surgery Department of Jiangsu University Affiliated Hospital from January 2019 to July 2022.The data included demographic information(height,gender,weight,age),serum biochemical markers of general health and bone metabolism(including albumin,alkaline phosphatase,parathyroid hormone,25-hydroxyvitamin D3,and insulin-like growth factor-1),and the Singh index of the healthy side of the hip joint assessed by X-ray.The patients were classified into three groups(mild,moderate,and severe)according to the severity of the Singh index.Mann-Whitney U test and Spearman’s correlation analysis were used to compare the differences in general data and serum biochemical markers between the three groups.Ordered logistic regression was used to identify risk factors associated with the bone trabecular quality at the proximal femur.Statistical significance was set at P<0.05.Results(1)The non-parametric test indicated that there was no statistically significant difference(P>0.05)in clinical indicators between patients with femoral neck fractures and those with intertrochanteric fractures.(2)Univariate analysis results showed that there were significant differences in 25(OH)D3 and IGF-1 levels among the three groups of patients(P<0.05),among which the Singh index severe group had significantly lower 25(OH)D3(16.5(12.52～20.14))than the mild group(24.63(21.55～29.22)),with a significant difference(P=0.006);the Singh index severe group had significantly lower IGF-1(64.65(48.975～87.725))than the moderate group(90.2(69.55～133.4)),with a significant difference(P=0.025);correlation analysis results suggested that the severity of Singh index was negatively correlated with 25(OH)D3 and IGF-1 levels(P<0.05).(3)Ordered logistic regression results suggested that IGF-1 and 25(OH)D3 may be risk factors affecting Singh index classification.Conclusion The Singh index of proximal femoral trabecular bone type in middle-aged and elderly patients with hip fragility fracture was negatively correlated with serum 25(OH)D3 and IGF-1 levels,and serum 25(OH)D3 and IGF-1 levels may be important factors affecting bone quality in middle-aged and elderly patients with hip fragility fracture.Part 2 Study on the related factors of hip fragility fracture and bone metabolism biochemical indicators in middle-aged and elderly peopleObjective To study the characteristics of bone metabolism and biochemical markers in elderly patients with hip fragility fractures and explore the risk factors for hip fragility fractures.Methods From January 2019 to December 2022,71 elderly patients with hip fragility fractures(including femoral neck fractures and intertrochanteric fractures)were selected from the Department of Orthopedics and Joint Surgery of Jiangsu University Affiliated Hospital as the case group.A control group was selected by matching age and gender from non-fracture patients who visited the osteoporosis clinic of the same hospital.Information on demographic data(height,gender,weight,and age),serum general biochemical indicators,and 25-hydroxyvitamin D3(25(OH)D3)bone metabolism-related biochemical indicators was recorded for both groups.Based on the actual measured value of 25(OH)D3,all patients were divided into severely deficient,deficient,insufficient,or sufficient groups according to China’s current diagnostic criteria for 25(OH)D3.The RxC table was used to test the distribution of 25(OH)D3 between the case and control groups,and Cox proportional hazards regression analysis was used to explore the risk factors for hip fragility fractures.All statistical tests were performed at a significance level of P<0.05.Results(1)After matching for age and gender,there was no significant difference in age and gender between the two groups(P>0.05),while there was a statistically significant difference in 25(OH)D3 between the two groups(P=0.007);(2)The RxC table showed that among the 6 patients in the severely deficient group,5 were in the case group,accounting for 83%,and 1 was in the control group,accounting for 16.7%.Among the 11 patients in the deficient group,9 were in the case group,accounting for 82%,and 2 were in the control group,accounting for 18%.Among the 35 patients in the insufficient group,16 were in the case group,accounting for 46%,and 19 were in the control group,accounting for 54%.Among the 14 patients in the sufficient group,3 were in the case group,accounting for 21%,and 11 were in the control group,accounting for 79%.There was a significant difference in the distribution of 25(OH)D3 between the case and control groups(P=0.001);(3)The Cox regression analysis results showed that 25(OH)D3 was an independent risk factor for hip fragility fractures,and for every one-unit increase in 25(OH)D3,the risk of hip fragility fractures decreased by 10.8%.Conclusion:Hip fragility fractures in elderly patients are related to low serum 25(OH)D3 levels,and serum 25(OH)D3 level is an important factor affecting the occurrence of hip fragility fractures in the elderly. |
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