Carboxy terminal collagen crosslinks as a prognostic risk factor for fall-related fractures in individuals with established spinal cord injury

Spinal Cord, 2019 · DOI: 10.1038/s41393-019-0322-0 · Published: July 15, 2019

Spinal Cord Injury Musculoskeletal Medicine

Simple Explanation

This study investigated the relationship between bone turnover markers and fall-related fractures in people with spinal cord injuries (SCI). Researchers measured levels of specific markers in the blood of 106 participants with SCI. The study found that high levels of a marker called CTX were associated with a greater risk of fractures during the one-year follow-up period. Other markers, like vitamin D, calcium, and PTH, were not linked to fracture risk in this group. The authors suggest that CTX levels could potentially be used to identify individuals with SCI who are at higher risk for fractures, but further research with larger groups of people is needed to confirm this.

Study Duration

1 year

Participants

106 individuals with spinal cord injury

Evidence Level

Prospective cohort study

Key Findings

1
High serum levels of carboxy terminal collagen crosslinks (CTX) increased the odds of being in the fracture group.
2
Vitamin D, calcium, parathyroid hormone (PTH), and type-1 procollagen N-terminal (P1NP) levels were not associated with being in the fracture group.
3
Increased time after injury was associated with a higher risk of fracture at baseline.

Research Summary

This study investigated the association between bone turnover markers and fall-related fractures in 106 individuals with spinal cord injury (SCI) over a 1-year follow-up period. The primary finding was that higher levels of serum CTX (carboxy terminal collagen crosslinks) at baseline were associated with an increased risk of fall-related fractures during the follow-up. The authors suggest that CTX levels could be a potential risk factor to consider in addition to common risk assessment scores for fracture risk in individuals with SCI, but further research is needed.

Practical Implications

Fracture Risk Assessment

CTX plasma levels may be a useful biomarker to incorporate into fracture risk assessments for individuals with SCI.

Monitoring Osteoporosis Treatment

CTX levels could be used to monitor the effectiveness of osteoporosis treatment in individuals with SCI, similar to its use in the able-bodied population.

Further Research

Larger studies are needed to confirm the association between CTX levels and fracture risk in individuals with SCI.

Study Limitations

1
Relatively few fractures occurred during the 1-year follow-up, potentially leading to misinterpretation of statistical calculations.
2
Inclusion of ambulatory subjects could reduce the prognostic value of the dataset for those with complete injuries.
3
The study focused on fall-related fractures, which may include fractures other than fragility fractures associated with sub-lesional osteoporosis.

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