Factor analysis of biochemical and clinical indicators of aseptic necrosis of the femoral head

Borodin S.V., Volkov E.E., Gordeev M.V., Goloshchapov A.P.

Abstract


Introduction
The study of pathogenesis and improving the diagnosis of aseptic necrosis of the femoral head (ANFH) is one of the challenging problems of regenerative orthopedics. ANFH is a polyetiologic disease characterized by a local increase in the resorption activity of osteoclasts along with inhibition of activity of mesenchymal cells and osteoblasts, which lead to a significant loss of bone tissue. In this connection, it seems to us relevant to study biochemical and clinical markers of bone resorption and remodeling as diagnostic criteria for ANFH.
The purpose of the study was to identify the relationship of some biochemical markers of bone tissue metabolism that reflect the balance between resorption and remodeling with clinical ones (gender, age, T- and Z-criteria), evaluate specifically the deficit of vitamin D in patients with ANFH.
Materials and methods
Clinical and biochemical study included 195 people with a verified diagnosis of aseptic necrosis of the femoral head who had not previously received vitamin D preparations. They were 87 men and 108 women aged 18 to 88 years.
Results
In the course of the study, the deficiency of vitamin D of varying severity was revealed in 69.7% of the subjects diagnosed with ANFH. Vitamin deficiency in males was higher than in women, 71.2% and 68.5 % respectively (p = 0.02). The average content of vitamin D was 26.5 ng/ml in women and 26.7 ng/ml in men which is lower than the optimal level (> 30 ng/ml). In addition, low values of vitamin D in women before and during the postmenopausal period were almost equal (68% and 68.7 %). In males over 50 years of age, the same tendency was observed: vitamin D deficiency was revealed in 64.6 % of men under 50 years and in 75.9 % over 50 years of age (p = 0.12). The most significant in magnitude and incidence of factorial connections with clinical characteristics were such biochemical parameters as Ca2+, (25OH)D and 1.25 (OH)2D in women and parathyroid hormone, osteocalcin, DPD in men.
Discussion
Analysis of correlations of biochemical indicators with clinical characteristics established that such indicators as the content of Ca2+, (25OH)D and 1.25 (OH)2D in women, and parathyroid hormone, osteocalcin and DPD in men were the most significant. In women, the most related clinical feature was age. Age correlated with the content of Ca2+, Ca, parathyroid hormone, DPD. It can be assumed that this is due to the biological aging of the female organism (menopause, osteoporosis).
Conclusion
The factor analysis enabled to determine the main groups of parameters that influence the variation of clinical and biochemical parameters in women and men diagnosed with ANFH, and also to identify the links between biochemical indicators and clinical features. This circumstance makes it possible to conduct a complex and differentiated assessment of metabolic disorders and to justify rational treatment tactics.

Keywords


aseptic necrosis of femoral head, vitamin D, biochemical parameters

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DOI: http://dx.doi.org/10.18019/1028-4427-2018-24-4-487-491

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