Study of Parameters of Osteosarcopenia in Patients With Hip Fracture

NCT ID: NCT04730622

Last Updated: 2025-05-18

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Total Enrollment

100 participants

Study Classification

OBSERVATIONAL

Study Start Date

2020-11-23

Study Completion Date

2025-12-31

Brief Summary

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The study aims to assess the adequacy of a set of clinical and laboratory investigations for identifying the osteosarcopenia status in patients undergoing a hip replacement for a fragility fracture of the femoral neck. The control group will consist of patients undergoing a hip replacement for osteoarthritis, as the decrease in muscle function and bone quality is less severe in this condition than in osteoporosis.

Detailed Description

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Osteoporotic hip fractures (fragility fractures) are common in older adults, and the risk of adverse outcomes and mortality is higher in patients affected by osteosarcopenia, a geriatric syndrome in which the low bone mineral density and bone microarchitecture deterioration (osteopenia/osteoporosis) are combined with a decline in mass, strength, and functional capacity of skeletal muscle (sarcopenia).

The diagnostic workup currently recommended to establish the severity of osteosarcopenia is hard to implement in individuals who arrive at the orthopedic emergency department with a fragility fracture. On the one hand, the evaluation of motility and physical performance is impracticable in bedridden patients; on the other hand, the surgical treatment priority does not allow performing all the instrumental investigations required for a proper diagnosis. In this context, reliable osteosarcopenia biomarkers could help identify most frail patients and plan for them personalized therapeutic interventions to promote postoperative recovery and reduce the risk of adverse outcomes.

Based on the new knowledge on the pathophysiology of osteosarcopenia, the investigators designed a small-scale study that aims to preliminarily verify the adequacy of a set of clinical and laboratory parameters that could be easily applied in hospitalized patients undergoing hip replacement for a fragility fracture. In particular, the investigators planned to assess the following:

* muscle performance by SARC-F questionnaire (acronym deriving from five domains considered in the questionnaire, i.e., strength, assistance with walking, rising from a chair, climbing stairs, and falls);
* dietary habits through a questionnaire on the intake frequency of food categories;
* histological features of osteoporosis and sarcopenia in tissue samples taken from the surgical site;
* the serum levels of markers associated with muscle-bone cross-talk (Myostatin, Insulin-like growth factor 1);
* the serum levels of the following pro-inflammatory cytokines to get a clearer picture of the presence of the inflammatory state: IL-6, IL-8, TNF-α;
* the serum levels of markers such as FGF-21, GDF15, soluble ST2, interesting markers of bone metabolism, indicators of bone mineral density, and modulators of osteoblast-osteoclast activity;
* the composition of the gut microbiota.

The study includes 100 patients who are candidates for hip replacement surgery (endo- and arthroplasty). As the decrease in muscle function and bone quality is more severe in fragility fractures than in osteoarthritis, the investigators expect to find differences in laboratory and clinical parameters.

Conditions

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Osteoporotic Fracture of Femur Osteoarthritis, Hip

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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Fragility fracture

Patients who are candidates for hip replacement surgery (endo- and arthroplasty).

SARC-F questionnaire

Intervention Type DIAGNOSTIC_TEST

Assessment of muscle performance based on self-reported information about grip strength, assistance with walking, rising from a chair, climbing stairs, and falls.

Bone tissue histology

Intervention Type DIAGNOSTIC_TEST

Assessment of histomorphology and matrix-structure of tissue samples obtained from the bone resected during the hip prosthesis positioning.

Muscle tissue histology

Intervention Type DIAGNOSTIC_TEST

Assessment of histomorphology and ultrastructure of muscle biopsies taken from the upper portion of the vastus lateralis muscle, which is accessed in the surgical procedure of hip replacement.

Myostatin serum levels

Intervention Type DIAGNOSTIC_TEST

Quantification of circulating myostatin, a muscle-specific biomarker that suppresses muscle growth and bone formation.

Insulin-like growth factor 1 (IGF-1) serum levels

Intervention Type DIAGNOSTIC_TEST

Quantification of circulating IGF-1, a growth factor that promotes muscle growth and osteogenesis.

Frequency food questionnaire

Intervention Type OTHER

Assessment of dietary habits based on self-reported information about the monthly- weekly- or daily-frequency consumption of main food groups, including cereals and bread, meat, fish, fruit, vegetable, legumes, dairy products, sweets and snacks, drinks, and dietary supplements.

Gut microbiota profiling

Intervention Type OTHER

Assessment of gut microbiome composition on stool samples.

Interventions

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SARC-F questionnaire

Assessment of muscle performance based on self-reported information about grip strength, assistance with walking, rising from a chair, climbing stairs, and falls.

Intervention Type DIAGNOSTIC_TEST

Bone tissue histology

Assessment of histomorphology and matrix-structure of tissue samples obtained from the bone resected during the hip prosthesis positioning.

Intervention Type DIAGNOSTIC_TEST

Muscle tissue histology

Assessment of histomorphology and ultrastructure of muscle biopsies taken from the upper portion of the vastus lateralis muscle, which is accessed in the surgical procedure of hip replacement.

Intervention Type DIAGNOSTIC_TEST

Myostatin serum levels

Quantification of circulating myostatin, a muscle-specific biomarker that suppresses muscle growth and bone formation.

Intervention Type DIAGNOSTIC_TEST

Insulin-like growth factor 1 (IGF-1) serum levels

Quantification of circulating IGF-1, a growth factor that promotes muscle growth and osteogenesis.

Intervention Type DIAGNOSTIC_TEST

Frequency food questionnaire

Assessment of dietary habits based on self-reported information about the monthly- weekly- or daily-frequency consumption of main food groups, including cereals and bread, meat, fish, fruit, vegetable, legumes, dairy products, sweets and snacks, drinks, and dietary supplements.

Intervention Type OTHER

Gut microbiota profiling

Assessment of gut microbiome composition on stool samples.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Patients who came to observation with femoral neck fracture of possible osteoporotic nature (no or minimal trauma) to be treated with endoprosthesis or hip arthroplasty.
* Competent patients who have signed consent to participate in the study (see Informed Consent section of this protocol).

Exclusion Criteria

* Previous osteoporotic fractures
* Previous prosthetic surgery for orthopedic diseases
* Pre-existing clinical conditions that led to permanent immobility
* Neoplastic diseases
* Autoimmune diseases
* Severe myopathies
* Chronic viral infections (HBV, HCV, HIV);
* Chronic treatment with anti-osteoporotic drugs, immunosuppressive drugs, and insulin
* Paget's disease
Minimum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Istituto Ortopedico Rizzoli

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Nicola Baldini, M.D.

Role: PRINCIPAL_INVESTIGATOR

University of Bologna, Istituto Ortopedico Rizzoli

Locations

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Istituto Ortopedico Rizzoli

Bologna, , Italy

Site Status RECRUITING

Countries

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Italy

Central Contacts

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Gemma Di Pompo, M.Sc.

Role: CONTACT

+39 0516366748

Facility Contacts

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Nicola Baldini, M.D.

Role: primary

+39 051 6366560

References

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Kirk B, Zanker J, Duque G. Osteosarcopenia: epidemiology, diagnosis, and treatment-facts and numbers. J Cachexia Sarcopenia Muscle. 2020 Jun;11(3):609-618. doi: 10.1002/jcsm.12567. Epub 2020 Mar 22.

Reference Type BACKGROUND
PMID: 32202056 (View on PubMed)

Wong RMY, Wong H, Zhang N, Chow SKH, Chau WW, Wang J, Chim YN, Leung KS, Cheung WH. The relationship between sarcopenia and fragility fracture-a systematic review. Osteoporos Int. 2019 Mar;30(3):541-553. doi: 10.1007/s00198-018-04828-0. Epub 2019 Jan 4.

Reference Type BACKGROUND
PMID: 30610245 (View on PubMed)

Kirk B, Al Saedi A, Duque G. Osteosarcopenia: A case of geroscience. Aging Med (Milton). 2019 Sep 8;2(3):147-156. doi: 10.1002/agm2.12080. eCollection 2019 Sep.

Reference Type BACKGROUND
PMID: 31942528 (View on PubMed)

Other Identifiers

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OsteoSarcopenia

Identifier Type: -

Identifier Source: org_study_id

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