Serum Inflammatory Markers in Osteoporotic Fracture Patients: A Survey in the Fracture Liaison Service at Shafayahyaeian Orthopedic Hospital, Tehran Province, Iran

Background: The fracture liaison service (FLS) is a healthcare model aimed at preventing refractures by diagnosing, investigating, and treating osteoporosis as soon as possible in patients with previous osteoporotic fragility fracture history. According to literature, secondary causes of osteoporosis can affect two-thirds of older men and 30% of postmenopausal women. Monoclonal gammopathy of uncertain significance, multiple myeloma, and chronic infectious diseases are crucial causes of secondary osteoporosis, and patients can present with fragility fractures as the first presentation of underlying disease. Measuring inflammatory markers, such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), is crucial for assessing secondary osteoporosis. The measurement of inflammatory markers, while easy to measure and affordable, can help guide the team to screen for secondary osteoporosis. Objectives: To analyze ESR and CRP levels in patients with osteoporotic fractures and to assess their associations with patients’ demographic and clinical characteristics.  Methods: This retrospective cross-sectional study included 1,979 patients enrolled in the FLS clinic of ShafaYahyaeian Orthopedic Hospital between October 2020 and May 2023. The primary outcome was to determine the percentage of patients with high ESR and CRP levels and investigate the relationship between these markers and demographic/clinical variables. Data were analyzed using SPSS software, version 26. Results: Of 1 979 patients, 32% had elevated ESR levels, and 40% had elevated CRP levels. Females, older patients, those with higher body mass index (BMI), and patients with lower bone mass density (BMD) had significantly higher ESR levels in the femoral neck, hip, and radius. Higher CRP levels were significantly associated with male sex, lower BMI, lower BMD in the radius, and lower serum vitamin D. Investigations were performed to rule out the causes of secondary osteoporosis, including malignancy and infection, in patients with elevated ESR and CRP. No cases of secondary osteoporosis were reported. Conclusion: Although about one-third of our patients had high ESR or CRP, no case of secondary osteoporosis was identified, suggesting that inflammatory factors are not investigated in the acute phase of fracture. The high levels of inflammatory factors in the early phase of fracture may be attributed to the physiological process of fracture healing.