In the Journals

Severe burn injury can alter bone metabolism

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February 8, 2016

Changes in bone turnover markers suggest that severe burn injuries lead to alterations in bone metabolism that can influence bone quality and structure, according to study findings.

“A severe thermal trauma causes early and sustained alterations in bone metabolism. To date there is limited information about the consequences of these changes, but elevated bone turnover is well known to cause structural and biomechanical changes in the skeleton,” Christian Muschitz, MD, head of the osteoporosis unit and clinical research team, St. Vincent Hospital Vienna, Academic Teaching Hospital of the Medical University of Vienna, told Endocrine Today.

Christian Muschitz

Christian Muschitz

Muschitz and colleagues evaluated 32 consecutive male patients (mean age, 40.5 years) admitted to the burn ICU between August 2012 and August 2014 with acute, severe injuries due to a recreational or occupational accident. Participants had burn trauma over at least 20% the total body surface area and a burn severity of at least grade 2b. Twenty-seven (83%) of the patients had a partial full-thickness burn. Fasting serum samples were taken the day after trauma (day 2) and at days 7, 21 (± 2 days) and 56 (± 5 days). Samples were assayed for bone turnover markers and bone metabolism regulators, and measurements were compared between the early (days 2-7) and prolonged (days 7-56) phases after trauma.

Researchers found significant changes in all turnover markers and bone metabolism regulators.

In the early phase, the most prominent measures greater than the upper limit of normal were observed for procollagen type 1 N-terminal propeptide (P1NP), cross-linked C-telopeptide (CTX), sclerostin, dickkopf-1 protein (DKK1), bone-specific alkaline phosphatase (BALP), fibroblast growth factor 23 (FGF23) and intact parathyroid hormone (iPTH), whereas reductions were seen in albumin and 25-hydroxyvitamin D levels. Smaller but significant increases were observed in osteoprotegerin (OPG), osteocalcin (OCN) and phosphate. Concentrations of serum and iodized calcium were less than the lower limit of normal, whereas C-reactive protein (CRP) levels remained elevated in the early phase.

In the prolonged phase, the largest ongoing elevations were found for P1NP, sclerostin, OCN and BALP, and smaller increases were noted in albumin concentration. Late increases toward the upper limit of normal were seen in calcium and ionized calcium. Conversely, significant decreases were seen in concentrations of iPTH, FGF23, CRP and, to a smaller degree, CTX and phosphate. Researchers observed no changes in DKK1, soluble receptor activator of nuclear factor kappa-B ligand (sRANKL) and OPG levels.

“In adult male patients, rapid and sustained changes of markers of bone resorption, formation and regulators of bone metabolism through different pathways were observed,” the researchers wrote. “Ongoing changes of [bone turnover markers] and regulators of bone metabolism suggest alterations in bone metabolism with likely adverse influence on bone quality and structure in male patients with severe burn injuries.” – by Jennifer Byrne

For more information:

Christian Muschitz , MD, can be reached at christian.muschitz@meduniwien.ac.at.

Disclosure: Muschitz reports receiving speaker honoraria from Actavis, Amgen, Boehringer Ingelheim, Daiichi-Sankyo, Eli Lilly, Kwizda Pharma, Novartis, Nycomed Pharma/Takeda and Servier, and receiving educational grants/research support from the Austrian Society for Bone and Mineral Research, Amgen Austria Eli Lilly Austria, Eli Lilly International and Roche Austria. Please see the full study for a list of all other author’ relevant financial disclosures.