Markers of bone remodelling, bone density and endocrine response after polytraumas and burns

The concept of the Acute Phase Response (APR) is explained. 29 patients after polytraumas (evaluated by ISS criteria) and 28 burned patients (evalu­ ated by their Burn Index, BI) were followed. At regular intervals their bone resorption (ACP, CTX, DPD, PHP) and bone formation (ALP, osteocalcin, PICP) markers were examined as well as iPTH, total and ionized kalcium, inorganic phosphates (iP), 250H vit. D3, testosterone (T), dihydrotestoste­ rone (DHT), free testosterone (FT), cortisol, 17pestradiol, DHEA-S, TNFa, Interleukin-6 (IL-6), IL-8, IL-10 and sIL-2R. The blood samples of the trau­ ma patients were taken at days 1-7-14-28, of the burned at 1-7-14-28-56, as well as after 6 and 12 months. The changes of the BMD (bone mineral den­ sity) were examined (densitometry) 6 and 12 months after burns (L 1-4 and the femoral neck). After burns (BU) and after polytraumas (PT), the levels of bone resorption markers were increased for a long time (after BU even for months). The increased levels of bone formation markers were found la­ ter too. All androgens (T, DHT, FT) decreased significantly in the males (M), in whom DHEA-S dropped often as well (in females, F, too). In both M and F, the 17p-estradiol levels rose relatively often, as well as testosterone occasionally in F. Cortisol values were generally high or elevated (both in blood and as the free cortisol in urine). Both in PT and BU, the levels of IL-6, IL-8, and IL-10 were elevated or high, especially in the beginning, du­ ring complications. The TNFa levels were elevated too.The sIL-2R levels were high to very high, especially in septic events, both in F and M, in PT and BU. The bone resorption markers were high to very high, they remained high in BU for many weeks. The bone formation markers were elevated too, usually somewhat later. The calcium (total and ionized) was usually immediately post PT or BU decreased. The latter was relatively often followed by elevated or even very high PTH values. The values of 250H vit. D3 were generally in lower ranges, even very low sometimes. A long-term follow-up of the above patients is necessary. It is suggested (clinical studies are prepared) to administer immediately post BU or PT a single vitamin D3 injection i.m., possibly anabolics as well. For bone protection, after severe BU or PT, calcitonin administration is suggested.

Keywords: acute phase response, polytrauma, burn injury, androgens, estrogens, cytokines, ma cium, iPTH, 250H vitamin D3, cortisol, BMD, densitometry, bone changes, therapeutic options.