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Open Access Research article

Time course of 25(OH)D3 vitamin D3 as well as PTH (parathyroid hormone) during fracture healing of patients with normal and low bone mineral density (BMD)

Christoph Wöfl1*, Sarah Englert1, Arash A Moghaddam1, Gerald Zimmermann2, Gerhard Schmidt-Gayk3, Bernd Höner4, Aidan Hogan1, Marcus Lehnhardt5, Paul A Grützner1 and Leila Kolios5

Author Affiliations

1 Department of Trauma- and Orthopaedic Surgery, BG Trauma Centre Ludwigshafen, Ludwig- Guttmann-Str.13, Ludwigshafen 67071, Germany

2 Department of Trauma and Orthopaedic Surgery, TKH Mannheim, Bassemannstrasse 1, Mannheim, 68156, Germany

3 Clinical Laboratory Limbach, Im Breitspiel 15, Heidelberg, 69126, Germany

4 Department of Social and Legal Sciences, SRH Hochschule, Heidelberg, Ludwig-Guttmann-Str.6, Heidelberg, 69123, Germany

5 Department of Plastic-, Reconstructive and Hand surgery, Burn Care Centre, BG Unfallklinik Ludwigshafen, Ludwig-Guttmann-Str.13, Ludwigshafen, 67071, Germany

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BMC Musculoskeletal Disorders 2013, 14:6  doi:10.1186/1471-2474-14-6

Published: 3 January 2013

Abstract

Background

Until now the exact biochemical processes during healing of metaphyseal fractures of healthy and osteoporotic bone remain unclear. Especially the physiological time courses of 25(OH)D3 (Vitamin D) as well as PTH (Parathyroid Hormone) the most important modulators of calcium and bone homeostasis are not yet examined sufficiently. The purpose of this study was to focus on the time course of these parameters during fracture healing.

Methods

In the presented study, we analyse the time course of 25(OH)D3 and PTH during fracture healing of low BMD level fractures versus normal BMD level fractures in a matched pair analysis. Between March 2007 and February 2009 30 patients older than 50 years of age who had suffered a metaphyseal fracture of the proximal humerus, the distal radius or the proximal femur were included in our study. Osteoporosis was verified by DEXA measuring. The time courses of 25(OH)D3 and PTH were examined over an eight week period. Friedmann test, the Wilcoxon signed rank test and the Mann-Withney U test were used as post-hoc tests. A p-value ≤ 0.05 was considered significant.

Results

Serum levels of 25(OH)D3 showed no differences in both groups. In the first phase of fracture healing PTH levels in the low BMD level group remained below those of the normal BMD group in absolute figures. Over all no significant differences between low BMD level bone and normal BMD level bone could be detected in our study.

Conclusions

The time course of 25(OH)D3 and PTH during fracture healing of patients with normal and low bone mineral density were examined for the first time in humans in this setting and allowing molecular biological insights into fracture healing in metaphyseal bones on a molecural level. There were no significant differences between patients with normal and low BMD levels. Hence further studies will be necessary to obtain more detailed insight into fracture healing in order to provide reliable decision criteria for therapy and the monitoring of fracture healing.