title: Changes in serum levels of receptor activator of nuclear factor-kappaB ligand, osteoprotegerin, IL-6 and TNF-alpha in patients with a concomitant head injury and fracture.
abstract: BACKGROUND
  Several reports indicated that interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF- alpha) play important regulatory roles in bone remodeling and homeostasis. In addition, receptor activator of nuclear factor-kappaB ligand (RANKL) and osteoprotegerin (OPG) have been shown to be important regulators of osteoclastogenesis during bone remodeling, and their expressions were examined during fracture healing in a mouse model of tibial fracture. However, studies linking RANKL, OPG, IL-6 and TNF-alpha in patients with head injury and fracture are lacking.
  
  
  METHODS
  Within the first few hours of admission to hospital and at 4, 8, and 12 weeks after the injury, we evaluated changes in serum levels of RANKL, OPG, IL-6 and TNF-alpha in 24 male patients with a concomitant head injury and fracture and in 26 male patients with fracture only. These levels were compared with those found in 36 healthy controls.
  
  
  RESULTS
  The RANKL/OPG ratios were found to significantly lower in patients with a concomitant head injury and fracture than in the controls immediately after admission and at 4, 8, and 12 weeks after the injury. In addition, RANKL/OPG ratios were significantly lower in patients with a concomitant head injury and fracture than in those with fracture at 8 and 12 weeks after the injury. The serum IL-6 levels were significantly higher in patients with a concomitant head injury and fracture than in the controls upon admission, and at 4, 8, and 12 weeks after the injury. Moreover, the serum IL-6 levels were significantly higher in patients with a head injury and fracture than in those with just a fracture at 4, 8, and 12 weeks after the injury.
  
  
  CONCLUSIONS
  Based on these changes in the profiles of RANKL, OPG, and IL-6 and the RANKL/OPG ratio, altered repair of a fracture can occur in patients with a concomitant head injury and fracture.
authors.affiliation: Department of Orthopaedic Surgery, Medical Research Institute, Pusan National University School of Medicine, Pusan, South Korea.
authors.forename: Jung Sub
authors.initials: JS
authors.lastname: Lee
authors.forename: Chang Hoon
authors.initials: CH
authors.lastname: Ryu
authors.forename: Nam Hoon
authors.initials: NH
authors.lastname: Moon
authors.forename: Seong-Jang
authors.initials: SJ
authors.lastname: Kim
authors.forename: Shin Young
authors.initials: SY
authors.lastname: Park
authors.forename: Kuen Tak
authors.initials: KT
authors.lastname: Suh
mesh_terms: D000328:Adult; D015897:Comorbidity; D006259:Craniocerebral Trauma / Q000097:blood / Q000453:epidemiology*; D005264:Femoral Fractures / Q000097:blood / Q000453:epidemiology; D017102:Fracture Healing / Q000502:physiology*; D050723:Fractures, Bone / Q000097:blood / Q000453:epidemiology* / Q000503:physiopathology*; D015600:Glasgow Coma Scale; D006408:Hematoma, Subdural / Q000097:blood / Q000453:epidemiology; D006801:Humans; D006810:Humeral Fractures / Q000097:blood / Q000453:epidemiology; D015850:Interleukin-6 / Q000097:blood*; D020198:Intracranial Hemorrhage, Traumatic / Q000097:blood / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D053244:Osteoprotegerin / Q000097:blood*; D053245:RANK Ligand / Q000097:blood*; D013978:Tibial Fractures / Q000097:blood / Q000453:epidemiology; D014409:Tumor Necrosis Factor-alpha / Q000097:blood*; D055815:Young Adult
chemical_list: D015850:Interleukin-6; D053244:Osteoprotegerin; D053245:RANK Ligand; D014409:Tumor Necrosis Factor-alpha