The Correlation Between Bone Turnover Markers And Bone Mineral Density In Premature Ovarian Insufficiency

Objective:To compare the sex hormones,serum lipids,bone turnover markers and bone mineral density among normal bone mass group,osteopenia group and osteoporosis group of patients with premature ovarian insufficiency(POI),to further analyze the relationship among N-terminal propeptide of type1 precollagen(P1NP),?C-terminal telopeptide of type?collagen(?-CTX),Alkaline phosphatase(ALP)and bone mineral density(BMD),and to investigate the predictive value of bone turnover markers for bone loss and fracture risk in POI patients.Method:1.60 POI patients diagnosed in the Gynecological Endocrine clinic of the second hospital of Hebei Medical University from December 2017 to December 2018 were selected as research subjects.BMD at various skeletal sites(lumbar spine,left hip and femoral neck)were measured by dual energy X.ray absorptiometry in 60 patients with POI;According to BMD results,the patients were divided into normal bone mass group(T?-1.0 or Z>-2.0),osteopenia group(2.5-<T<-1.0 or Z<-2.0)and osteoporosis group(T?-2.5);Determination of sex hormones:follicle-stimulating hormone(FSH),estradiol(E2),anti-Mullerian hormone(AMH);Blood lipids:total cholesterol(TC),triglyceride(TG),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C);Bone turnover markers:P1NP,?-CTX and ALP levels.Serological parameters mentioned above were compared among the three groups;The level of P1NP,?-CTX and ALP in serum were determined by electrochemical luminescence to analyze their correlation with BMD at various skeletal sites.2.The clinical data and measured values of each indicator of all patients were recorded in the Excel table,and SPSS 21.0 statistical software was used for professional statistical processing.Results:1.Description of general data and analysis of clinical featuresThere were no significant difference in age,body mass index and menstrual change types between the three groups(P>0.05).Chromosome karyotype abnormalities were found in 6 patients,accounting for 10%;iatrogenic POI was found in 9 patients,accounting for 15%;immune and endocrine factors was found in 9 patients,accounting for 15%;idiopathic POI was found in 36 patients,accounting for 60%.2.Serological parameters among different groupsThe median value of serum FSH was 87.93(63.79,121.37)mIU/mL,the median value of E2 was 17.00(9.00,30.75)pg/mL,and the median value of AMH was 0.06(0.05,0.10)ng/mL.The median value of TC was 4.60(4.09,5.14)mmol/L,the median value of TG was 1.045(0.81,1.29)mmol/L,the median value of HDL-C was 1.41(1.26,1.64)mmol/L,and the median value of LDL-C was 2.97(2.55,3.32)mmol/L.The median value of P1NP was 74.60(46.76,133.37)ng/ml,and the median value of ALP was 86.0(64.25,120.00)U/L.There was no significant difference in the above serological parameters among the three groups(P>0.05).The median value of?-CTX was 0.38(0.31,0.59)ng/ml,and the difference between the three groups was statistically significant(P=0.044).3.Correlation between bone turnover markers and BMDP1NP,?-CTX and ALP were respectively divided into four groups according to the 25th,50th and 75th quartile for the comparison of BMD(g/cm~2)at different skeletal sites.The BMD of lumbar spine,left hip and femoral neck between different P1NP groups were statistically significant,and P1NP was negatively correlated with BMD of all the three parts(P<0.01).The BMD of left hip between different?-CTX groups were statistically significant with a weak negative correlation(P<0.05).The BMD of lumbar spine and left hip between different groups of ALP was statistically significant and negatively correlated(P<0.01).Conclusion:1.This study showed that the etiology of most POI patients was unknown,and patients with chromosomal karyotype abnormalities,chemotherapy history,immune and endocrine diseases were relatively common.2.There were no statistically significant difference in the levels of sex hormones and blood lipids in POI women among the groups of normal bone mass,osteopenia and osteoporosis.3.P1NP was negatively correlated with BMD of lumbar spine,left hip and femoral neck,ALP was negatively correlated with BMD of lumbar spine and left hip,and?-CTX was negatively correlated with BMD of left hip.4.Bone turnover markers may predict bone loss and fracture risk in POI patients.