Bone turnover biomarkers predict one-year all-cause mortality and walking ability in geriatric hip fracture patients

Rongjie Wu; Yuanchen Ma; Duanyong Chen; Mengyuan Li; Zeng Li; Zhantao Deng; Qiujian Zheng; Guangtao Fu

doi:10.1016/j.bone.2023.116922

Bone turnover biomarkers predict one-year all-cause mortality and walking ability in geriatric hip fracture patients

Bone. 2023 Dec:177:116922. doi: 10.1016/j.bone.2023.116922. Epub 2023 Sep 27.

Authors

Rongjie Wu¹, Yuanchen Ma², Duanyong Chen³, Mengyuan Li², Zeng Li², Zhantao Deng², Qiujian Zheng⁴, Guangtao Fu⁵

Affiliations

¹ Department of Orthopedics, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, PR China; Shantou University Medical College, Shantou, Guangdong Province, PR China.
² Department of Orthopedics, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, PR China.
³ Department of Orthopedics, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, PR China; Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, PR China.
⁴ Department of Orthopedics, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, PR China. Electronic address: zhengqiujian@gdph.org.cn.
⁵ Department of Orthopedics, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, PR China. Electronic address: fuguangtao@gdph.org.cn.

PMID: 37775069
DOI: 10.1016/j.bone.2023.116922

Abstract

Purpose: To investigate the utility of serum C-terminal cross-linking telopeptides (β-CTX) and procollagen type I N propeptide (PINP) for predicting one-year mortality and walking ability in Chinese geriatric hip fracture patients who underwent surgical interventions.

Method: Elderly patients (≥ 60 years) who underwent surgical interventions for unilateral low-energy hip fracture from 2015 to 2020 in our center were included. Demographic data was retrospectively retrieved from the electronic medical database. The PINP and β-CTX concentrations were measured before the surgery. The patients were divided into two groups according to the outcome of mortality and walking ability after hip surgery, respectively. β-CTX and PINP were divided into four grades based on quartiles [Quartile(Q)1-4] for further analysis. All the variables with p < 0.1 in univariable analysis were included in a multivariable model.

Results: In univariable analysis, the levels of serum β-CTX (p = 0.007) and PINP (p = 0.025) was associated with one-year mortality, while the association between levels of serum β-CTX (p = 0.072) or PINP (p = 0.055) with one-year disability was marginally significant. After adjustment for confounders, the relative risk [OR (95 % CI), Q4 v sQ1, p-value] of one-year mortality and one-year disability were 7.28 (2.08-29.78, p = 0.003) and 3.97 (1.44-11.69, p = 0.009) for β-CTX and 5.87 (1.70-23.80, p = 0.008) and 3.48 (1.30-9.93, p = 0.016) for PINP, respectively. The coefficient of determination, AUC and bias-corrected C-index of predictive models based on previously reported predictors were significantly improved after integrating β-CTX or PINP.

Conclusion: Higher serum β-CTX and PINP are independently associated with an increased risk of one-year mortality and disability in patients with hip fractures. The application of BTMs improves the performance of currently available predictive models.

Keywords: Born turnover markers; Disability; Hip fracture; Mortality.