Main Article Content
Bone Fractures, Calcium, Phosphorus, Alkaline phosphatase, 25-Hydroxyvitamin D2
Background : The recovery of long bones after fracture requires a specific process to restore the natural bone anatomy as well as its proper function. Changes in calcium, phosphorus, alkaline phosphatase and 25-hydroxy vitamin D can be justified either in the fracture process or in the repair procedure. The aim of this sectional study is to investigate changes in all these compounds after the surgical repair of fractures of femur and tibia bones.
Materials and Methods : A random sample of 68 patients was selected from whom referring to a hospital with fractures of femur or tibia and candidate for repair surgery. The mentioned bone markers were measured at the time after surgery, six and twelve weeks after the surgery with laboratory-specific kits. A p-value, lower than 0.05, was considered to be statistically significant.
Result : Of the patients, 34 were with fractures of femur and 34 were with fractures of tibia, equally. The patients were aged 2 to 69 with a mean age of 27.93 14.8 years old. The means of calcium (p = 0.001) and phosphorus (p = 0.014) at three intervals were statistically significant difference. In contrast, The means serum alkaline phosphatase and vitamin D levels did not show any significant changes over time (p = 0.042).
Conclusion : The means of calcium and phosphorus over the follow-up were statistically significant. The observed difference of vitamin D after the surgery between male and female is one of our important findings.
2. Dvorak G, Fügl A, Watzek G, Tangl S, Pokorny P, Gruber R. Impact of dietary vitamin D on osseointegration in the ovariectomized rat. Clin Oral Implants Res 2012;23(11):1308-1313.
3. Bogunovic L, Kim AD, Beamer BS, Nguyen J, Lane JM. Hypovitaminosis D in patients scheduled to undergo orthopaedic surgery: a single-center analysis. J Bone Joint Surg Am 2010;92(13):2300.
4. Nurmi I, Kaukonen J-P, Lüthje P, Naboulsi H, Tanninen S, Kataja M, et al. Half of the patients with an acute hip fracture suffer from hypovitaminosis D: a prospective study in southeastern Finland. Osteoporos Int 2005;16(12):2018-2024.
5. Sahota O, Mundey MK, San P, Godber IM, Lawson N, Hosking DJ. The relationship between vitamin D and parathyroid hormone: calcium homeostasis, bone turnover, and bone mineral density in postmenopausal women with established osteoporosis. Bone 2004;35(1):312-319.
6. Doetsch AM, Faber J, Lynnerup N, Wätjen I, Bliddal H, Danneskiold–Samsøe B. The effect of calcium and vitamin D 3 supplementation on the healing of the proximal humerus fracture: a randomized placebo-controlled study. Calcif Tissue Int 2004;75(3):183-188.
7. Fu L, Tang T, Miao Y, Hao Y, Dai K. Effect of 1, 25-dihydroxy vitamin D3 on fracture healing and bone remodeling in ovariectomized rat femora. Bone 2009;44(5):893-898.
8. Anderson PH, Lam NN, Turner AG, Davey RA, Kogawa M, Atkins GJ, et al. The pleiotropic effects of vitamin D in bone. J Steroid Biochem Mol Biol 2013;136:190-194.
9. Sprague S, Petrisor B, Scott T, Devji T, Phillips M, Spurr H, et al. What is the role of vitamin D supplementation in acute fracture patients? A systematic review and meta-analysis of the prevalence of hypovitaminosis D and supplementation efficacy. J Orthop Trauma 2016;30(2):53-63.
10. Reid IR, Bolland MJ, Grey A. Effect of calcium supplementation on hip fractures. Osteoporos Int 2008;19(8):1119-1123.
11. Oppl B, Michitsch G, Misof B, Kudlacek S, Donis J, Klaushofer K, et al. Low bone mineral density and fragility fractures in permanent vegetative state patients. J Bone Miner Res 2014;29(5):1096-1100.
12. Angthong C, Angthong W, Harnroongroj T, Harnroongroj T. A comparison of survival rates for hip fracture patients with or without subsequent osteoporotic vertebral compression fractures. Tohoku J Exp Med 2012;226(2):129-135.
13. Uzoigwe CE, Venkatesan M, Smith R, Burnand HGF, Young PS, Cheesman CL, et al. Serum lactate is a prognostic indicator in patients with hip fracture. Hip Int 2012;22(5):580-584.
14. Bourne GH. Alkaline phosphatase and vitamin C deficiency in regeneration of skull bones. J Anat 1948;82(Pt 1-2):81.
15. Buring K, Semb H. Enzyme patterns during bone induction. Calcif Tissue Res 1970;4(1):102-104.
16. Eddy WH, Heft HL. The Relation of Fracture Healing to the Inorganic Phosphorus of the Blood Serum. J Biol Chem 1923;55:12.
17. Firschein HE, Urist MR. The induction of alkaline phosphatase by extraskeletal implants of bone matrix. Calcif Tissue Res 1971;7(1):108-113.
18. Vrijens K, Lin W, Cui J, Farmer D, Low J, Pronier E, et al. Identification of small molecule activators of BMP signaling. Plos One 2013;8(3).
19. Sato Y, Kaji M, Higuchi F, Yanagida I, Oishi K, Oizumi K. Changes in bone and calcium metabolism following hip fracture in elderly patients. Osteoporos Int 2001;12(6):445-449.
20. Li P-F, Lin Z-L, Pang Z-H, Zeng Y-R. Does serum calcium relate to different types of hip fracture? A retrospective study. Chin J Traumatol 2016;19(5):275-277.
21. Ettehad H, Mirbolook A, Mohammadi F, Mousavi M, Ebrahimi H, Shirangi A. Changes in the serum level of vitamin d during healing of tibial and femoral shaft fractures. Trauma Monthly 2014;19(1).
22. Nilsson BE, Westlin NE. The plasma concentration of alkaline phosphatase, phosphorus and calcium following femoral neck fracture. Acta Orthop Scand 1972;43(6):504-510.