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Serum Biomarkers Related to Glucocorticoid‐Induced Osteonecrosis of the Femoral Head: A Prospective Nested Case‐Control Study
Author(s) -
Wang XinYuan,
Hua BingXuan,
Jiang Chang,
Yuan HengFeng,
Zhu Liang,
Fan WenShuai,
Ji ZongFei,
Wang Zhe,
Yan ZuoQin
Publication year - 2019
Publication title -
journal of orthopaedic research®
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.041
H-Index - 155
eISSN - 1554-527X
pISSN - 0736-0266
DOI - 10.1002/jor.24400
Subject(s) - femoral head , medicine , glucocorticoid , nested case control study , prospective cohort study , case control study , surgery
Early diagnosis and prevention of glucocorticoid (GC)‐induced osteonecrosis of the femoral head (ONFH) continues to be a challenging problem for clinicians and researchers. However, the role of circulating biomarkers for GC‐induced ONFH, which may reveal individual susceptibility and facilitate earlier diagnosis, remains to be determined. The aim of this study was to identify potential biomarkers that may predict early GC‐induced ONFH. A total of 123 patients scheduled for initial systemic GC therapy were enrolled in this prospective nested case–control study. The serum concentrations of 13 potential biomarkers were measured in seven patients with GC‐induced ONFH, diagnosed instantly after short‐term use of GCs and in 20 controls who did not develop osteonecrosis despite similar GC therapy. Biomarkers were measured both before and after taking GCs to identify any differences in marker levels and the changes during GC therapy between two groups. Type I collagen cross‐linked C‐telopeptide (β‐CTX; p = 0.000) was significantly lower, high‐density lipoprotein cholesterol ( p = 0.092) and apolipoprotein (apo)‐B/apo‐A1 ( p = 0.085) tended to be lower and higher, respectively, before GC treatment in osteonecrosis group. After GC therapy, β‐CTX ( p = 0.014) was significantly lower and amino terminal telopeptide of procollagen type I (PINP; p = 0.068) tended to be lower in the osteonecrosis group. As secondary outcomes, we observed remarkable changes in nine potential biomarkers following short‐term GC therapy in both groups. In conclusion, we found that β‐CTX, could potentially be used to predict GC‐induced ONFH before GC therapy. Lower β‐CTX and PINP are promising biomarkers for the early diagnosis of GC‐induced ONFH. These findings need to be confirmed in large‐scale prospective studies. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:2348–2357, 2019