Clin Osteol 2015; 20(3): 107-122

Burns and bones (bone changes after burns)Original contributions

R. Doleček, Z. Crkvenjaš-Němečková, L. Pleva, J. Tvrdík, Z. Švagera

Osteoporosis following burns has been repeatedly reported. The main objectives were to monitor 28 various markers in a group of 73 burnt patients (12 females, 61 males) on 7 occasions throughout a year (Days 1, 7, 14, 28, 56, 183 and 365), and to determine which markers could contribute to the development of osteoporosis, with general catabolism in acute phase response (APR) that may be ex­ cessive. So far, there are no clear criteria for such excessiveness although it has been repeatedly shown to exist. For six to twelve months, bone resorption markers such as CTX, NTX, PHP, DPD and, partly, acid phosphatase were significantly in­ creased. For several weeks, the levels of catabolic interleukin-6 were increased; IL-10 was slightly increased for only a week after burns were sustained. Males had a decrease in anabolism resulting from a significant decrease in testosterone, dihydrotestosterone and f-testosterone lasting for several weeks. Both males and females had a temporary significant decrease in DHEA-S. Following burns, the le­ vels of ionized calcium (iCa) and total calcium (tCa) in blood are significantly lower, with the decreased lasting for longer in case of iCa. The concentrations of PTH were relatively normal, with exceptions noted. In those who died after sustaining burns, however, the con­ centrations were often very high. Following burns, the levels of "anabolism" markers gradually rise such as alkaline phosphatase (ALP), osteocalcin, IGF-1 and des-acyl ghrelin. Initially, burn patients typically have high levels of 17P-estradiol; cortisol levels are close to the upper limit of the normal range, with some extremely high as well as low levels being present. Urinary free cortisol was high for seve­ ral weeks. The mean levels of calcidiol, or 25 (OH)D, were lower than normal, and low in many individuals. There was a significant difference in many markers following burns and polytrauma. After polytrauma, PTH was very high, blocking IL-10 was high, both iCa and tCa were less reduced, and 17P-estradiol was lower. There was a high increase in ALP in polytrauma. Apparently, APR is sometimes excessive which might even cause harm to the burnt patient. In treatment, anabolics should be consi­ dered; an attempt to reduce the excessive APR should be made (successful administration should be therefore remembered); and vitamin D3 should be administered following burns.

Keywords: burns, bone, hormones, bone metabolism

Published: December 11, 2015  Show citation