Predictive effect of femoral neck strength composite indexes on femoral head collapse in non-traumatic osteonecrosis of femoral head_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIN Tianye ^1,2 , YANG Peng ^1,2 , CAI Kaishen ^1,2 , LI Ziqi ^2,3 , PANG Fengxiang ^1,2 , ZHANG Qingwen ^2,3 , HE Wei ^2,3 ,  WEI Qiushi ^2,3

1. The First Clinical Medical College of Guangzhou University of Traditional Chinese Medicine, Guangzhou Guangdong, 510080, P.R.China;
2. Guangdong Research Institute of Orthopedics and Traumatology of Chinese Medicine, Guangzhou Guangdong, 510405, P.R.China;
3. The Third Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou Guangdong, 510405, P.R.China;

Corresponding author：

WEI Qiushi, Email: 20194109092@stu.gzucm.edu.cn

Keywords：

Osteonecrosis of the femoral head; femoral head collapse; femoral neck strength composite indexes; bone turnover marker; prediction

DOI：

10.7507/1002-1892.202103168

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Objective To explore the predictive effect of the femoral neck strength composite indexes on femoral head collapse in non-traumatic osteonecrosis of the femoral head (ONFH) compared with bone turnover marker.Methods The non-traumatic ONFH patients who were admitted and received non-surgical treatment between January 2010 and December 2016 as the research object. And 96 cases (139 hips) met the selection criteria and were included in the study. There were 54 males (79 hips) and 42 females (60 hips), with an average age of 40.2 years (range, 22-60 years). According to whether the femoral head collapsed during follow-up, the patients were divided into collapsed group and non-collapsed group. The femoral neck width, hip axis length, height, body weight, and bone mineral density of femoral neck were measured. The femoral neck strength composite indexes, including the compressive strength index (CSI), bending strength index (BSI), and impact strength index (ISI), were calculated. The bone turnover marker, including the total typeⅠcollagen amino terminal elongation peptide (t-P1NP), β-crosslaps (β-CTx), alkaline phosphatase (ALP), 25 hydroxyvitamin D [25(OH)D], and N-terminal osteocalcin (N-MID), were measured. The age, gender, height, body weight, body mass index (BMI), bone mineral density of femoral neck, etiology, Japanese Osteonecrosis Investigation Committee (JIC) classification, femoral neck strength composite indexes, and bone turnover marker were compared between the two groups, and the influencing factors of the occurrence of femoral head collapse were initially screened. Then the significant variables in the femoral neck strength composite indexes and bone turnover marker were used for logistic regression analysis to screen risk factors; and the receiver operating characteristic (ROC) curve was used to determine the significant variables’ impact on non-traumatic ONFH. Results All patients were followed up 3.2 years on average (range, 2-4 years). During follow-up, 46 cases (64 hips) had femoral head collapse (collapsed group), and the remaining 50 cases (75 hips) did not experience femoral head collapse (non-collapsed group). Univariate analysis showed that the difference in JIC classification between the two groups was significant (Z=–7.090, P=0.000); however, the differences in age, gender, height, body weight, BMI, bone mineral density of femoral neck, and etiology were not significant (P>0.05). In the femoral neck strength composite indexes, the CSI, BSI, and ISI of the collapsed group were significantly lower than those of the non-collapsed group (P<0.05); in the bone turnover marker, the t-P1NP and β-CTx of the collapsed group were significantly lower than those of the non-collapsed group (P<0.05); there was no significant difference in N-MID, 25(OH)D or ALP between groups (P>0.05). Multivariate analysis showed that the CSI, ISI, and t-P1NP were risk factors for femoral collapse in patients with non-traumatic ONFH (P<0.05). ROC curve analysis showed that the cut-off points of CSI, BSI, ISI, t-P1NP, and β-CTx were 6.172, 2.435, 0.465, 57.193, and 0.503, respectively, and the area under the ROC curve (AUC) were 0.753, 0.642, 0.903, 0.626, and 0.599, respectively. Conclusion The femoral neck strength composite indexes can predict the femoral head collapse in non-traumatic ONFH better than the bone turnover marker. ISI of 0.465 is a potential cut-off point below which future collapse of early non-traumatic ONFH can be predicted.

Citation： LIN Tianye, YANG Peng, CAI Kaishen, LI Ziqi, PANG Fengxiang, ZHANG Qingwen, HE Wei, WEI Qiushi. Predictive effect of femoral neck strength composite indexes on femoral head collapse in non-traumatic osteonecrosis of femoral head. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(8): 967-972. doi: 10.7507/1002-1892.202103168 Copy

1.	Peng Y, Liu Y, Huang D, et al. Association of TNF-α-308(G/A) and -238(G/A) polymorphisms with non-traumatic osteonecrosis of the femoral head risks: a meta-analysis. Int Orthop, 2018, 42(7): 1711-1721.
2.	Nam KW, Kim YL, Yoo JJ, et al. Fate of untreated asymptomatic osteonecrosis of the femoral head. J Bone Joint Surg (Am), 2008, 90(3): 477-484.
3.	孙海忠, 韦标方. 髋关节外科脱位打压植骨术与髓芯减压支撑植骨术治疗ARCO Ⅲ期股骨头缺血性坏死疗效比较. 中国修复重建外科杂志, 2019, 33(5): 531-536.
4.	Han L, Wang B, Wang R, et al. The shift in the balance between osteoblastogenesis and adipogenesis of mesenchymal stem cells mediated by glucocorticoid receptor. Stem Cell Res Ther, 2019, 10(1): 377. doi: 10.1186/s13287-019-1498-0.
5.	Gangji V, Soyfoo MS, Heuschling A, et al. Non traumatic osteonecrosis of the femoral head is associated with low bone mass. Bone, 2018, 107: 88-92.
6.	Kanis JA, McCloskey EV, Johansson H, et al. A reference standard for the description of osteoporosis. Bone, 2008, 42(3): 467-475.
7.	Siris ES, Chen YT, Abbott TA, et al. Bone mineral density thresholds for pharmacological intervention to prevent fractures. Arch Intern Med, 2004, 164(10): 1108-1112.
8.	郑小龙, 何晓铭, 龚水帝, 等. 酒精性股骨头坏死患者的骨转换特点. 中国组织工程研究, 2021, 25(5): 657-661.
9.	Yoon BH, Mont MA, Koo KH, et al. The 2019 revised version of association research circulation osseous staging system of osteonecrosis of the femoral head. J Arthroplasty, 2020, 35(4): 933-940.
10.	Karlamangla AS, Barrett-Connor E, Young J, et al. Hip fracture risk assessment using composite indices of femoral neck strength: the Rancho Bernardo study. Osteoporos Int, 2004, 15(1): 62-70.
11.	Kamal KC, Alexandru DO, Rogoveanu OC, et al. Immunohistochemical analysis of bone metabolism in osteonecrosis of the femoral head. Rom J Morphol Embryol, 2018, 59(3): 819-824.
12.	Tian L, Baek SH, Jang J, et al. Imbalanced bone turnover markers and low bone mineral density in patients with osteonecrosis of the femoral head. Int Orthop, 2018, 42(7): 1545-1549.
13.	Xu M, Motomura G, Ikemura S, et al. Proximal femoral morphology after transtrochanteric posterior rotational osteotomy for osteonecrosis of the femoral head: A three-dimensional simulation study. Orthop Traumatol Surg Res, 2020, 106(8): 1569-1574.
14.	Finianos B, Zunquin G, El Hage R. Composite indices of femoral neck strength in middle-aged inactive subjects vs former football players. J Clin Densitom, 2021, 24(2): 214-224.
15.	Yang P, Lin TY, Xu JL, et al. Finite element modeling of proximal femur with quantifiable weight-bearing area in standing position. J Orthop Surg Res, 2020, 15(1): 384. doi: 10.2139/ssrn.3506162.
16.	Kerboul M, Thomine J, Postel M, et al. The conservative surgical treatment of idiopathic aseptic necrosis of the femoral head. J Bone Joint Surg (Br), 1974, 56(2): 291-296.
17.	Nishii T, Sugano N, Ohzono K, et al. Significance of lesion size and location in the prediction of collapse of osteonecrosis of the femoral head: a new three-dimensional quantification using magnetic resonance imaging. J Orthop Res, 2002, 20(1): 130-136.
18.	Yu N, Liu YJ, Pei Y, et al. Evaluation of compressive strength index of the femoral neck in Caucasians and Chinese. Calcif Tissue Int, 2010, 87(4): 324-332.
19.	Nishizawa Y, Ohta H, Miura M, et al. Guidelines for the use of bone metabolic markers in the diagnosis and treatment of osteoporosis (2012 edition). J Bone Miner Metab, 2013, 31(1): 1-15.
20.	Zhang J, Zhang T, Xu X, et al. Zoledronic acid combined with percutaneous kyphoplasty in the treatment of osteoporotic compression fracture in a single T₁₂ or L₁ vertebral body in postmenopausal women. Osteoporos Int, 2019, 30(7): 1475-1480.
21.	Shi Z, Jin H, Ding Q, et al. Bone turnover markers may predict the progression of osteonecrosis of the femoral head in aged males. Ann Transl Med, 2019, 7(22): 626. doi: 10.21037/atm.2019.11.22.
22.	Civitelli R, Armamento-Villareal R, Napoli N. Bone turnover markers: understanding their value in clinical trials and clinical practice. Osteoporos Int, 2009, 20(6): 843-851.
23.	Kubiak RW, Zelnick LR, Hoofnagle AN, et al. Mineral metabolism disturbances and arteriovenous fistula maturation. Eur J Vasc Endovasc Surg, 2019, 57(5): 719-728.
24.	Pan C, Liu X, Li T, et al. Kinetic of bone turnover markers after osteoporotic vertebral compression fractures in postmenopausal female. J Orthop Surg Res, 2018, 13(1): 314. doi: 10.1186/s13018-018-1025-5.

1. Peng Y, Liu Y, Huang D, et al. Association of TNF-α-308(G/A) and -238(G/A) polymorphisms with non-traumatic osteonecrosis of the femoral head risks: a meta-analysis. Int Orthop, 2018, 42(7): 1711-1721.
2. Nam KW, Kim YL, Yoo JJ, et al. Fate of untreated asymptomatic osteonecrosis of the femoral head. J Bone Joint Surg (Am), 2008, 90(3): 477-484.
3. 孙海忠, 韦标方. 髋关节外科脱位打压植骨术与髓芯减压支撑植骨术治疗ARCO Ⅲ期股骨头缺血性坏死疗效比较. 中国修复重建外科杂志, 2019, 33(5): 531-536.
4. Han L, Wang B, Wang R, et al. The shift in the balance between osteoblastogenesis and adipogenesis of mesenchymal stem cells mediated by glucocorticoid receptor. Stem Cell Res Ther, 2019, 10(1): 377. doi: 10.1186/s13287-019-1498-0.
5. Gangji V, Soyfoo MS, Heuschling A, et al. Non traumatic osteonecrosis of the femoral head is associated with low bone mass. Bone, 2018, 107: 88-92.
6. Kanis JA, McCloskey EV, Johansson H, et al. A reference standard for the description of osteoporosis. Bone, 2008, 42(3): 467-475.
7. Siris ES, Chen YT, Abbott TA, et al. Bone mineral density thresholds for pharmacological intervention to prevent fractures. Arch Intern Med, 2004, 164(10): 1108-1112.
8. 郑小龙, 何晓铭, 龚水帝, 等. 酒精性股骨头坏死患者的骨转换特点. 中国组织工程研究, 2021, 25(5): 657-661.
9. Yoon BH, Mont MA, Koo KH, et al. The 2019 revised version of association research circulation osseous staging system of osteonecrosis of the femoral head. J Arthroplasty, 2020, 35(4): 933-940.
10. Karlamangla AS, Barrett-Connor E, Young J, et al. Hip fracture risk assessment using composite indices of femoral neck strength: the Rancho Bernardo study. Osteoporos Int, 2004, 15(1): 62-70.
11. Kamal KC, Alexandru DO, Rogoveanu OC, et al. Immunohistochemical analysis of bone metabolism in osteonecrosis of the femoral head. Rom J Morphol Embryol, 2018, 59(3): 819-824.
12. Tian L, Baek SH, Jang J, et al. Imbalanced bone turnover markers and low bone mineral density in patients with osteonecrosis of the femoral head. Int Orthop, 2018, 42(7): 1545-1549.
13. Xu M, Motomura G, Ikemura S, et al. Proximal femoral morphology after transtrochanteric posterior rotational osteotomy for osteonecrosis of the femoral head: A three-dimensional simulation study. Orthop Traumatol Surg Res, 2020, 106(8): 1569-1574.
14. Finianos B, Zunquin G, El Hage R. Composite indices of femoral neck strength in middle-aged inactive subjects vs former football players. J Clin Densitom, 2021, 24(2): 214-224.
15. Yang P, Lin TY, Xu JL, et al. Finite element modeling of proximal femur with quantifiable weight-bearing area in standing position. J Orthop Surg Res, 2020, 15(1): 384. doi: 10.2139/ssrn.3506162.
16. Kerboul M, Thomine J, Postel M, et al. The conservative surgical treatment of idiopathic aseptic necrosis of the femoral head. J Bone Joint Surg (Br), 1974, 56(2): 291-296.
17. Nishii T, Sugano N, Ohzono K, et al. Significance of lesion size and location in the prediction of collapse of osteonecrosis of the femoral head: a new three-dimensional quantification using magnetic resonance imaging. J Orthop Res, 2002, 20(1): 130-136.
18. Yu N, Liu YJ, Pei Y, et al. Evaluation of compressive strength index of the femoral neck in Caucasians and Chinese. Calcif Tissue Int, 2010, 87(4): 324-332.
19. Nishizawa Y, Ohta H, Miura M, et al. Guidelines for the use of bone metabolic markers in the diagnosis and treatment of osteoporosis (2012 edition). J Bone Miner Metab, 2013, 31(1): 1-15.
20. Zhang J, Zhang T, Xu X, et al. Zoledronic acid combined with percutaneous kyphoplasty in the treatment of osteoporotic compression fracture in a single T₁₂ or L₁ vertebral body in postmenopausal women. Osteoporos Int, 2019, 30(7): 1475-1480.
21. Shi Z, Jin H, Ding Q, et al. Bone turnover markers may predict the progression of osteonecrosis of the femoral head in aged males. Ann Transl Med, 2019, 7(22): 626. doi: 10.21037/atm.2019.11.22.
22. Civitelli R, Armamento-Villareal R, Napoli N. Bone turnover markers: understanding their value in clinical trials and clinical practice. Osteoporos Int, 2009, 20(6): 843-851.
23. Kubiak RW, Zelnick LR, Hoofnagle AN, et al. Mineral metabolism disturbances and arteriovenous fistula maturation. Eur J Vasc Endovasc Surg, 2019, 57(5): 719-728.
24. Pan C, Liu X, Li T, et al. Kinetic of bone turnover markers after osteoporotic vertebral compression fractures in postmenopausal female. J Orthop Surg Res, 2018, 13(1): 314. doi: 10.1186/s13018-018-1025-5.

Chinese Journal of Reparative and Reconstructive Surgery

Predictive effect of femoral neck strength composite indexes on femoral head collapse in non-traumatic osteonecrosis of femoral head

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