The Clinical Value Of β-CTx And P1NP Detection In Evaluating Risks Of Fragile Fracture In Postmenopausal Women With Osteoporosis

The clinical value of p-CTx and P1NP detection in evaluating risks of fragile fracture in postmenopausal women with osteoporosisOsteoporosis is a common disease characterized by low bone mineral density,increased bone turnover,and deterioration of bone microarchitecture.At present,the internationally recognized method of bone density examination is dual energy X-ray absorption method(DXA).Bone metabolic markers are a class of metabolic markers derived from bone matrix or bone cells that have important diagnostic value for the evaluation and treatment of osteoporosis.The BTM can not only be used to monitor the effectiveness and efficacy of osteoporosis patients,but also can be used to predict the risk of fractures.Under normal metabolic conditions,the two kinds of markers remain in a state of dynamic equilibrium.In the case of osteoporosis,the bone metabolism balance was broken,the bone turnover increased,and the two kinds of markers showed some changes.In the latest guidelines for the diagnosis and treatment of osteoporotic fracture,P1NP and P-CTx are recommended as a highly sensitive marker of bone turnover by the International Osteoporosis Foundation.Part 1:The clinical value of β-CTx and P1NP in evaluation of fragile fracture risk in postmenopausal women with osteoporosisObjective To explore the predictive value of bone turnover markers in postmenopausal women with osteoporotic fracture.Methods 51 cases of postmenopausal osteoporotic fracture were selected as experimental group and 84 patients with osteoporosis were treated as the control group from 1560 patients from June 2013 to June 2015.P1NP and β-CTx level and Bone mineral density at the lumbar spine or the hip was measured.The correlation data of the two groups was compared and analyzed,and the ROC curve was calculated to estimate the value of β-CTx and P1NP in postmenopausal women with osteoporosis fracture.Results The β-CTx level of the two group was respectively 549.37 ± 283.05(pg/ml)and 348.24 ± 243.94(pg/ml),and the difference between two groups was statistically significant(t=4.32,P<0.01).The P1NP level of the two group was respectively 55.53±24,17(ng/ml)and 42.00±24.69(ng/ml),and the difference between two groups was also statistically significant(t=3.07,P<0.01).The area of ROC curve of β-CTx and P1NP was 0.815 and 0.667 respectively,and the threshold value ofβ-CTx and P1NP were 472.972(pg/ml)and 28.946(ng/ml).Conclusion The high serum level of P-CTx is the fracture risk factor of postmenopausal osteoporosis.The predictive value of β-CTx for osteoporotic fractures is higher than P1NP,when the level of β-CTx reaches 472.972(pg/ml)above,it indicates a high fracture risk.Part 2:The application of β-CTx and P1NP in the healing of osteoporotic fracture in postmenopausal womenObjective To investigate the role of β-CTx and P1NP in the diagnosis and treatment of osteoporotic fracture,and to investigate the change characteristics of bone metabolism during osteoporotic fracture healing.Methods 560 postmenopausal women with osteoporosis were followed up from Jan 2014 to Jan 2016;Excluding those who do not meet the conditions and lost following up,and 51 cases of osteoporotic fracture were selected from the 560 postmenopausal women.At the same time,40 elderly women without fracture were randomly selected as control group.The bone density value of each patient was tested.The level of P1NP and P-CTx in the control group at the first visit and patients in the experimental group within 48 hours,third month,sixth month and twelfth month was detected.Then two sets of data were analyzed.Results The level of β-CTx in the experimental group,at 48 hours,third month,sixth month,twelfth month was respectively(554.14±301.12pg/ml,682.41±293.55pg/ml,594.21 ±268.35pg/ml,556.25±298.24pg/ml),and the level of P1NP was respectively(55.5±24.13ng/ml,69.52±34.52ng/ml,59.02±30.25ng/ml,56.63±28.17ng/ml).The level of P-CTx and P1NP in the control group was:(348.65±244.67)pg/ml and(41.89±24.58)ng/ml.It was significantly higher in the experimental group than the control group(P<0.01).The level of P1NP and β-CTx was significantly increased in postmenopausal women with osteoporotic fracture(P<0.01).Conclusion The level of P1NP and β-CTx increased significantly after low energy fracture in-patient with osteoporosis.The level of P1NP and β-CTx was significantly increased in the osteoporotic fracture after third month,and the value of twelfth month is also at a high level.Part 3:Analysis of Fosamax’ influence on bone turnover marker of postmenopausal osteoporosis womenObjective To observe the effect of Fosamax on bone turnover marker in postmenopausal women with primary osteoporosis.Methods 30 postmenopausal women with OP were followed up for more than 1 years from Jan 2014 to Jan 2016.The patient took orally a pill of Caltrate D every day and Fosamax(2800IU)70 mg per week,treatment for one year.The level of β-CTx and P1NP was detected before treatment,in the treatment of third months,sixth months,twelfth months,and bone mineral density of all the patient was measured before treatment,sixth months and twelfth months after treatment.After one year of taking Fosamax,The change level of β-CTx and P1NP was analyzed in postmenopausal osteoporosis patients.Results After a week of taking orally administration Fosamax,The level of BTMdecreased significantly(P<0.01).β-CTx was decreased respectively by 52.49%,60.25%,76.85%at the time of third month,sixth month,twelfth month compared with pre-treatment,and P1NP decreased respectively by 33.14%、46.37%、53.62%.The decline rate of β-CTx is larger than that of P1NP,Compared with the pre-treatment,and the two markers were significantly decreased at each time point(all P<0.01).Fosamax can enhance BMD in postmenopausal OP patients.The BMD of L2-4 was 833±124g/m3 and 857±117g/m3 at sixth month and twelfth month,the difference wassignificant compared with the pre-treatment(p<0.05).Conclusion Fosamax can significantly increase the BMD and decrease the rate of BTM in postmenopausal women with OP.After third month of treatment,the rate of BTM decreased significantly;then the rate of decline gradually slowed down.