Elevated Neopterin Levels Predict Early Death in Older Hip-fracture Patients.
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ABSTRACT:
SUBMITTER: Larsen M
PROVIDER: S-EPMC5832560 | biostudies-literature | 2017 Dec
REPOSITORIES: biostudies-literature
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Elevated Neopterin Levels Predict Early Death in Older Hip-fracture Patients.
Larsen Martin M Bayard Charles C Lepetitcorps Hélène H Cohen-Bittan Judith J Appay Victor V Boddaert Jacques J Sauce Delphine D
EBioMedicine 20171106
Our society faces a major challenge concerning management of the health and socio-economic burden caused by acute physical stress in the older population (+75years). In particular, hip-fracture surgery (HFS) represents a major health care preoccupation, affecting 1.6 million patients worldwide, resulting in a significant drop in life quality and autonomy. The trauma is associated with 20-30% one-year mortality in the elderly. In the present study, we aim to identify factors, which influence and/ ...[more]
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Project description:Sarcopenia is an important risk factor for hip fracture in older people. Nevertheless, this condition is overlooked in clinical practice. This study aimed to explore the factors associated with sarcopenia among older patients hospitalized for hip fracture, to identify a predictive model of sarcopenia based on variables related to this condition, and to evaluate the performance of screening tools in order to choose the most suitable to be adopted in routine care of older people with hip fracture. A cross-sectional study was undertaken with 90 patients (mean age 83.4 ± 7.2 years), by assessing sociodemographic and clinical characteristics, anthropometric measures, such as body mass index (BMI) and calf circumference (CC), the functional status (Barthel Index), the nutritional status (MNA-SF), and the adherence to the Mediterranean Diet (MEDAS). Diagnosis of sarcopenia was established according to the criteria of the European Working Group on Sarcopenia in Older People (EWGSOP2). The analysis of variables associated with sarcopenia was performed using multivariate logistic regression models. Clusters of sarcopenia were explored with heatmaps and predictive risk models were estimated. Sarcopenia was confirmed in 30% of hip fracture patients. Variables with the strongest association with sarcopenia were BMI (OR = 0.79 [0.68−0.91], p < 0.05) and CC (OR = 0.64 [0.51−0.81], p < 0.01). CC showed a relatively high predictive capacity of sarcopenia (area under the curve: AUC = 0.82). Furthermore, CC could be a valuable tool to predict sarcopenia risk compared with the currently used screening tools, SARC-F and SARC-CalF (AUC, 0.819 vs. 0.734 and 0.576, respectively). More studies are needed to validate these findings in external study populations.
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Project description:There are currently no robust noninvasive markers of fragility fractures. Secreted frizzled related protein-1 (sFRP-1), dickkopf-related protein 1 (DKK1) and DKK2, and sclerostin (SOST) inhibit Wnt signaling and interfere with osteoblast-mediated bone formation. We evaluated associations of serum levels of sFRP-1, DKK1, DKK2, and SOST with incident low-impact fracture and BMD in 828 women aged ≥65 years from EpiDoC, a longitudinal population-based cohort. A structured questionnaire during a baseline clinical appointment assessed prevalent fragility fractures and clinical risk factors (CRFs) for fracture. Blood was collected to measure serum levels of bone turnover markers and Wnt regulators. Lumbar spine and hip BMD were determined by DXA scanning. Follow-up assessment was performed through a phone interview; incident fragility fracture was defined by any new self-reported low-impact fracture. Multivariate Cox proportional hazard models were used to analyze fracture risk adjusted for CRFs and BMD. During a mean follow-up of 2.3 ± 1.0 years, 62 low-impact fractures were sustained in 58 women. A low serum DKK2 level (per 1 SD decrease) was associated with a 1.5-fold increase in fracture risk independently of BMD and CRFs. Women in the two lowest DKK2 quartiles had a fracture incidence rate of 32 per 1000 person-years, whereas women in the two highest quartiles had 14 fragility fractures per 1000 person-years. A high serum sFRP1 level was associated with a 1.6-fold increase in fracture risk adjusted for CRFs, but not independently of BMD. Serum levels of SOST (r = 0.191; p = 0.0025) and DKK1(r = -0.1725; p = 0.011) were correlated with hip BMD, but not with incident fragility fracture. These results indicate that serum DKK2 and sFRP1 may predict low-impact fracture. The low number of incident fractures recorded is a limitation and serum levels of Wnt regulators should be further studied in other populations as potential noninvasive markers of fragility fractures. © 2019 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.
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