Relationship between serum BSAP and β-CTX changes and recurrent vertebral fractures in patients treated with zoledronic acid after osteoporotic vertebral compression fracture
Objective To investigate the relationship between changes of serum bone-specific alkaline phosphatase(BSAP),β collagen degradation products(β-CTX)and recurrent vertebral fractures in patients treated with zoledronic acid after osteoporotic vertebral compression fracture.Methods A totol of 156 patients who underwent percutaneous vertebroplasty(PVP)/percutaneous kyphoplasty(PKP)combined with zoledronic acid for OVCF in Zhejiang Greentown Cardiovascular Hospital from April 2020 to March 2022 were selected.The patients were divided into a re-fracture group and a non-re-fracture group according to whether there were recurrent vertebral fractures 2 years after surgery.The serum levels of BSAP and β-CTX were compared between the two groups 1 day before surgery and 1 and 3 months after surgery.Logistic regression model was used to analyze the risk factors of recurrent fracture after OVCF surgery.The predictive value of serum BSAP and β-CTX on the risk of recurrent fracture after OVCF was analyzed by receiver operating characteristic(ROC)curve.Results During 2-year follow-up,a total of 29 patients(18.6％)suffered recurrent vertebral fractures.One day before surgery and 1 and 3 months after surgery,serum BSAP[(23.3±4.3)U/L,(21.6±4.0)U/L,and(17.6±3.3)U/L]and β-CTX[(582±55)pg/ml,(534±41)pg/ml,and(498±58)pg/ml]levels in re-fracture group were higher than those of BSAP[(18.3±5.0)U/L,(16.7±4.0)U/L,and(13.0±2.7)U/L],β-CTX[(551±53)pg/ml,(503±51)pg/ml,and(467±38)pg/ml]in non-re-fracture group(P＜0.05).Compared with 1 day before surgery,the serum BSAP and β-CTX levels in 2 groups were decreased 1 and 3 months after surgery,and the levels in 3 months after surgery were lower than those in 1 month after surgery(P＜0.05).The proportion of age,Cobb Angle change and poor bone cement dispersion in re-fracture group was higher than that in non-re-fracture group,and the preoperative bone mineral density was lower than that in non-re-fracture group(P＜0.05).Multivariate Logistic regression model analysis showed that higher serum BSAP,β-CTX,higher age and poor bone cement diffusion 1 day before surgery were independent risk factors for postoperative recurrence fracture in OVCF patients with Zoledronate combined with PVP/PKP,and higher preoperative bone density was independent protective factor(P＜0.05).ROC results showed that the AUC(95％CI)of serum BSAP predicting the risk of recurrent vertebral fracture in OVCF patients with Zoledronate combined with PVP/PKP was 0.856(0.783,0.923)1 day before surgery,0.606(0.518,0.690)and 0.635(0.547,0.717),respectively,1 month and 3 months after surgery.Serum β-CTX were 0.873(0.762,0.941),0.691(0.607,0.768),0.703(0.618,0.779),and the predictive value of serum BSAP and β-CTX 1 day before surgery was the highest(P＜0.05).Conclusion Preoperative serum levels of BSAP,β-CTX,age,preoperative bone density,and bone cement dispersion are all associated with the combination of zoledronic acid and PVP/PKP in the treatment of recurrent vertebral fractures after OVCF surgery,and preoperative levels of BSAP and β-CTX are of great significance in predicting recurrent vertebral fractures after OVCF surgery.
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