Bone mineral density and bone turnover markers in war veterans after lower limb amputation

Background. The war in Ukraine has led to an increase in the number of amputations, which are a common cause of disuse osteoporosis. The purpose was to assess bone mineral density (BMD), vitamin D status, and serum bone turnover markers in war veterans with unilateral lower limb amputation resulting from mine-blast injuries. Materials and methods. A total of 64 men aged 20–54 years were examined and divided into two groups. The control group included 32 healthy subjects, while the study group consisted of 32 men with transfemoral (TFA) or transtibial (TTA) amputations (median post-amputation period (PAP): 5.0 [4.0–7.0] months). BMD was assessed using dual-energy X-ray absorptiometry (Discovery Wi, Hologic). Laboratory evaluation included parameters of calcium-phosphorus metabolism, bone remodeling markers, and serum 25-hydroxyvitamin D (25(OH)D). Results. BMD of the hip and femoral neck on the amputated side was significantly lower compared to controls (0.78 ± 0.22 vs. 1.00 ± 0.20 g/cm2; p = 0.0002 and 0.66 ± 0.20 vs. 0.87 ± 0.14 g/cm2; p = 0.00002, respectively). However, no significant differences were found for the contralateral limb compared to controls. Low BMD (Z ≤ –2 SD) on the amputated side was detected in 39–42 % of the persons from the study group, but not in contralateral limbs or controls. Bone loss in the amputated limb was ~ 20 % compared to the contralateral side, increasing with PAP duration, and was more pronounced in TFA than TTA. Vitamin D deficiency/insufficiency was found in 81 % of amputees, and higher P1NP level was found compared to controls. β-CTX level wase significantly higher in TFA group compared with controls. Conclusions. Men with traumatic unilateral lower limb amputations demonstrated significantly lower BMD in the amputated but not contralateral limb compared to controls. Bone loss was greater in TFA versus TTA and increased with PAP duration. A large proportion of amputees exhibited vitamin D deficiency/insufficiency and elevated serum P1NP level. These findings highlight the need to consider bone health in comprehensive rehabilitation programs for this patient group.