VALUE OF BONE REMODELLING MARKERS IN MANDIBULAR FRACTURE PATIENTS BY GENDER AND BONE MINERAL DENSITY

Abstract

Numerous studies have shown that fractures of the mandible are the most common injuries of the facial skeleton. The high incidence of such fractures is due to the anatomical and physiological characteristics of the mandible, as well as a variety of local and general causes. Disturbances in the structural-functional properties of bone tissue can occur as a result of internal and external influences and provide a favorable background for the development of fractures in various locations, including the mandible. A large number of regulatory factors of a nervous, humoral and immune nature, the presence of inflammation as an obligatory (first) phase of reparative regeneration after bone damage, dictate the need for an in-depth study of the structuralfunctional state of bone tissue in patients with traumatic injuries of the mandible, through the improvement of diagnostic and therapeutic methods. The aim of the study is to analyze the levels of bone remodeling markers in the oral fluid of patients with traumatic lesions of the mandible according to sex and BMD status compared with those of practically healthy control subjects (without general somatic and dental diseases). Materials and methods. The study is based on the results of laboratory tests on 151 people (main group) with mandibular fractures and 30 people (control group) without general somatic and dental diseases. The study included patients of both sexes aged 18-44 years: 92 (60,93%) male and 59 (39,07%) female patients. The levels of total calcium (Ca) and inorganic phosphorus (P) in the oral fluid were determined by photometric methods using commercial kits from «Filisit-Diagnostics» (Ukraine). The activity of alkaline phosphatase and acid phosphatase in oral fluid was determined by the kinetic method with n-nitrophenol phosphate. Oxyproline excretion was determined in daily urine using the Cobas test system (Roshe Diagnostics, Germany). Statistical processing of the study results was performed using Microsoft Excel and Statistics software packages for the statistical analysis of biomedical research data. Results and discussion. As a result of the studies, it was found that in men with osteoporosis, the levels of P in oral fluid were not significantly different from those in the control group, p>0,05. At the same time, the remaining values of bone remodeling markers in biological fluids were characterized by a pronounced imbalance, namely an increase in Ca content by 92,85%, p<0,01, p1<0,05, Ca/P ratio by 2,8 times, p, p1<0,01, AP activity by 89,48%, p<0,01, p1>0,05, ALP by 56,34%, p<0,05, p1>0,05, and urinary hydroxyproline level by 54,09%, p, p1<0,01, compared with the same data in the control group. In women with osteoporotic mandibular fractures, the values of all the parameters studied were significantly different from those of the control group. Thus, we found an increase in the oral fluid content of Ca – by 102,38%, p, p1<0,05, Ca/P ratio – by 3,5 times, p, p1<0,01, AP activity – by 99,06%, p, p1<0,01, ALP – by 65,15%, p, p1<0,01 against a decrease in the value of P – by 42,31%, p, p1<0,05, compared to the data of the control group. At the same time, in this subgroup of women there was an increase in urinary hydroxyproline by 58,26%, p, p1<0,01, compared to the data in the control group. Conclusions. Thus, analysis of bone remodeling marker levels showed that in patients with mandibular fractures due to destruction of the bone matrix as a result of trauma, there was an increase in osteoresorption activity that depended on the structural-functional state of the patients' bone tissue and was more pronounced in women.