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Changes in bone mass and bone turnover following ankle fracture
B M Ingle1, S M Hay, H M Bottjer
1Bone Metabolism Group, Section of Medicine, Division of Clinical Sciences, University of Sheffield, UK.
Summary
Ankle fracture causes significant bone loss in the ankle and hip, with bone density recovering at the ankle but not the hip over 52 weeks. Bone turnover markers initially increased but returned toward baseline.
Area of Science:
- Orthopedics
- Metabolic Bone Disease
- Biochemistry
Background:
- Bone loss and increased turnover are known local changes after fracture.
- The precise patterns of these changes following different fracture types remain unclear.
Purpose of the Study:
- To investigate changes in bone density and biochemical markers after ankle fracture.
- To assess recovery patterns of bone mineral density (BMD) and bone turnover markers.
Main Methods:
- 14 subjects with distal tibia and fibula fractures underwent BMD measurements (DXA, QUS) and biochemical marker analysis over 52 weeks.
- Bone formation markers (iBAP, Oc, PINP) and resorption markers (TRAcP, iFDpd, NTx) were quantified.
- The non-fractured limb served as a baseline control.
Main Results:
- Significant BMD decrease observed at the ultradistal ankle, trochanteric hip, and calcaneus (heel) QUS.
- Ankle BMD and heel velocity of sound (VOS) recovered by 52 weeks; trochanteric BMD and heel broadband ultrasound attenuation (BUA) did not.
- Bone formation markers increased significantly early post-fracture, with some remaining elevated at 52 weeks; resorption markers did not increase.
Conclusions:
- Ankle fracture leads to decreased BMD and altered bone turnover, affecting sites both distal and proximal to the fracture.
- Recovery of bone density is site-specific, with the ankle recovering but the hip showing persistent deficits.
- Bone turnover markers indicate an initial anabolic response followed by a return toward baseline levels.