Can P1NP Levels Influence Management Planning for Patients With a Fragility Hip Fracture Receiving Anti-resorptive...

Area of Science:

• Orthopedics and Bone Metabolism
• Geriatric Medicine
• Pharmacology

Background:

• Procollagen type 1 N-terminal propeptide (P1NP) is a biomarker for type I collagen synthesis and useful in monitoring anti-resorption medications.
• The clinical utility of P1NP in elderly patients with a history of fractures while on bisphosphonate therapy remains unclear.

Purpose of the Study:

• To assess serum P1NP levels in patients aged 60 years and older who experienced a hip fracture while undergoing osteoporosis treatment.
• To determine the association between P1NP levels and subsequent bone health management decisions, including therapy modifications and further investigations.

Main Methods:

• Retrospective descriptive cohort study (March 2017-September 2021) of patients aged ≥60 with fragility hip fractures on osteoporosis therapy.
• Serum P1NP levels were measured pre-operatively, with data extracted from hospital databases for quality improvement.

Main Results:

• Serum P1NP was tested in 58 of 2,303 fractures (2.5%). Mean age was 84.6 years; 58.6% were female.
• 31% had P1NP ≥40 ug/l, 10.3% had P1NP 36-39 ug/l, and 58.6% had suppressed P1NP (<35 ug/l).
• Among patients on therapy >5 years with suppressed P1NP, 55.6% had treatment discontinued and 22.2% had plans modified based on DXA results.

Conclusions:

• Pre-operative P1NP measurement supported multidisciplinary team (MDT) bone health planning in this cohort.
• P1NP levels, alongside DXA and clinical context, influenced MDT decisions, particularly for long-term treated patients.
• Findings suggest P1NP can aid in standardizing post-fracture bone health management, especially for patients on long-term therapy.