Does serum osteoprotegerin level relate to fragility fracture in elderly women with low vitamin D status?

BACKGROUND: Increased osteoprotegerin (OPG) with elevated bone turnover is supposed to be a homeostatic mechanism limiting bone loss. MATERIAL/METHODS: Whether osteoprotegerin relates to low-energy fracture in elderly women was investigated by analyzing the relationship between OPG and bone turnover. Sixty-nine women with a first fragility hip fracture participated. The reference group consisted of 23 age-matched women. Serum calcium, 25-OHD3, parathormone, osteocalcin (OC), cross-linked C-terminal telopeptides (CTX-I), tartrate-resistant acid phosphatase (TRAP5b), and osteoprotegerin were assayed immediately post-fracture. RESULTS: In both groups, median vitamin D and calcium concentrations were in the low reference range, CTX-I were moderately elevated, and TRAP5b activity and parathormone were within the reference range. Significantly lower osteocalcin, a trend to higher OPG, and an inverse correlation between OPG and osteocalcin was found in the fracture group. The distribution of fracture was related to osteocalcin and OPG concentrations: the lower the OC level, the higher the number of women with fracture at increasing OPG concentrations. A relative imbalance between bone formation and resorption was found in the fracture group. The lowest osteocalcin level (Q1) was observed only and vitamin 25-OHD3 insufficiency predominantly in the fracture group and higher OPG, TRAP5b, and elevated CTX-I concentrations (Q3) were found more often or predominantly in this group. CONCLUSIONS: The data demonstrate a relative imbalance between bone formation and resorption associated with fragility fracture in elderly women with low vitamin D status. The authors suggest that compensatory elevation of serum OPG, particularly with reduced bone formation, is insufficient to limit bone loss leading to fracture.

[Evaluation of IGF-1 concentration in serum and synovial fluid in women with different type coxarthrosis]. / Ocena stezenia IGF-1 w surowicy krwi i plynie stawowym u kobiet ze zmianami zwyrodnieniowymi stawu biodrowego o róznej etiologii.

Osteoarthritis is the greatest problem of aging population. It concerns particularly women over 65 years of age, in considerable degree limiting their locomotion activity. In recent years many different opinions on pathogenesis of osteoarthritis were presented, among them on the role of some growth factors like IGF-1 and TGF-beta playing an anabolic role in cartilage metabolism. The aim of our study was to compare the concentration of IGF-1 in clinically healthy women and women with coxarthrosis and to evaluate the association between IGF-1 in the serum and synovial fluid in relation to disease etiology. We found that in coxarthrosis of either idiopathic, necrotic or dysplastic etiology serum IGF-1 level was significantly lower than in control women (84.4; 76.1; 86.7 vs. 147.7 microg/ml). Concentration of IGF-1 in different groups of patients was similar or lower in synovial fluid than in the serum. Consistently decreased IGF-1 was found in synovial fluid (42.3 microg/ml) of patients with coxarthosis of necrotic origin. Our results suggest that low IGF-1 values, especially in synovial fluid, are in association with type of osteoarthritic changes within the joint, independently on age.

A comparative analysis of conservative and surgical treatment of Perthes' disease.

Background. The choice of treatment method for Perthes' disease is still a frequently encountered dilemma in orthopedic practice. The aim of our research was to compare outcomes after conservative and surgical treatment in patients with Perthes' disease. Material and methods. 72 children with Perthes' disease were included in the study group, of whom 29 were treated surgically. The outcome was evaluated by means of radiological parameters: the Wiberg angle, the femoral head sphericity according to Mose, the femoral antetorsion angle, and the cervical-metaphyseal angle. Results. The Wiberg angle at follow-up was significantly greater after surgical treatment, while the deviation from sphericity of the femur in the affected joint was significantly less. Sphericity of the femoral head was also significantly less in patients treated conservatively, but not as much so. The antetorsion angle was significantly smaller after surgery than before, but did not differ significantly in patients treated conservatively. The cervial-metaphyseal angle in the affected limb at check-up was signficantly less in patients treated surgically, but not in those treated conservatively. Conclusions. Surgical treatment gave considerably more "good" outcomes than did conservative methods. Femoral osteotomy is a good method of treatment for Perthes's disease, if performed at the right stage in the development of the disease.