Imbalanced bone turnover markers and low bone mineral density in patients with osteonecrosis of the femoral head

  • Lulu Tian
  • Seung-Hoon Baek
  • JinAn Jang
  • Shin-Yoon Kim
Original Paper



There have been few studies investigating the cumulative effect of individual factors related to bone metabolism on the systemic balance between bone formation and resorption in patients with osteonecrosis of the femoral head (ONFH). We investigated bone mineral density (BMD) of lumbar spine and bone turnover markers that reflect systemic bone metabolism.


Two-hundred twenty patients with ONFH were matched to 220 healthy subjects according to age, gender, and body mass index. ONFH patients were divided into steroid-induced (18%), alcoholic (21%), and idiopathic ONFH (61%) and subgroup analysis was performed to exclude the effect of steroid and malnutrition on bone metabolism. We compared lumbar spine bone mineral density (BMD) between groups and measured serum bone-specific alkaline phosphatase (BALP) and urinary deoxypyridinoline/creatinine (Dpd/Cr) ratio.


Logistic regression analysis revealed low spine BMD was significantly associated with each subgroup of ONFH when compared with that of the control group (odds ratio of 2.27, 4.24, and 1.86 in alcoholic, steroid, and idiopathic ONFH, respectively). The mean value of serum BALP (27.02 U/L) was within the normal reference range while average urine Dpd/Cr ratio (6.24 nM/mM) increased in ONFH group when compared with respective reference range.


Spine BMD decreased and urinary Dpd/Cr ratio increased in patients with non-traumatic ONFH. Further studies will be necessary to identify whether non-traumatic ONFH is merely a regional disease confined to the femoral head or may affect systemic bone metabolism.


Osteonecrosis of femoral head Bone mineral density Bone turnover makers Bone-specific alkaline phosphatase Deoxypyridinoline/creatinine ratio 



We thank professor Won Kee Lee for statistical analysis.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Research involving human participants and/or animals

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  • Lulu Tian
    • 1
  • Seung-Hoon Baek
    • 2
    • 3
  • JinAn Jang
    • 3
  • Shin-Yoon Kim
    • 1
    • 2
    • 3
  1. 1.Musculoskeletal Genome Research CenterKyungpook National University HospitalDaeguSouth Korea
  2. 2.Department of Orthopedic Surgery, School of MedicineKyungpook National UniversityDaeguSouth Korea
  3. 3.Department of Orthopedic SurgeryKyungpook National University HospitalDaeguSouth Korea

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