{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,18]],"date-time":"2026-07-18T09:27:32Z","timestamp":1784366852793,"version":"3.55.0"},"reference-count":47,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T00:00:00Z","timestamp":1760054400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Systemic inflammation has been linked to impaired bone remodeling and may contribute to the risk of osteoporotic fractures (OPFs). This study examined the relationship between baseline pan-immune-inflammation value (PIV) and bone turnover markers (BTMs) in patients hospitalized for the surgical treatment of OPFs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In this retrospective cross-sectional study, 839 patients aged \u226550\u202fyears who were treated for osteoporotic fragility fractures between 2017 and 2024 were analyzed. PIV was calculated as (neutrophils \u00d7 platelets \u00d7 monocytes)\/lymphocytes. BTMs included serum <jats:italic>\u03b2<\/jats:italic>-C-terminal telopeptide of type I collagen (\u03b2-CTX) and procollagen type I N-terminal propeptide (P1NP). Associations between log\u2082-transformed PIV and BTMs were assessed using multivariable generalized estimating equations (GEEs), adjusting for demographic, clinical, and biochemical factors. Smoothing spline models and threshold effect analyses were used to explore potential non-linear relationships. Subgroup analyses were conducted to examine effect modification.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The mean age of participants was 69.4\u202f\u00b1\u202f10.9\u202fyears, with 70.9% being female. Mean <jats:italic>\u03b2<\/jats:italic>-CTX and P1NP levels were 0.54\u202f\u00b1\u202f0.29\u202fng\/mL and 58.1\u202f\u00b1\u202f35.3\u202fng\/mL, respectively, and the mean log\u2082PIV was 8.24\u202f\u00b1\u202f1.28. Higher PIV levels were independently associated with lower BTMs. Specifically, each doubling of PIV was associated with a 4.46\u202fng\/mL reduction in P1NP and a 0.05\u202fng\/mL reduction in <jats:italic>\u03b2<\/jats:italic>-CTX (both <jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.001). An inverted J-shaped association was observed, with the relationship plateauing at log\u2082PIV levels between approximately 8.3 and 10.3. The inverse association was more pronounced in individuals with hypertension or impaired renal function.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Elevated PIV is independently and non-linearly associated with suppressed bone turnover, underscoring the role of systemic inflammation in the pathophysiology and management of osteoporosis.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2025.1660376","type":"journal-article","created":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T05:30:19Z","timestamp":1760074219000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Association between pan-immune-inflammation value and bone turnover markers in Chinese patients with osteoporotic fractures: a retrospective cross-sectional 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prospective studies","volume":"32","author":"Khaing","year":"2017","journal-title":"J Bone Miner Res"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"624","DOI":"10.1007\/s00223-024-01296-z","article-title":"Short-term changes in bone metabolism among transgender men starting gender-affirming hormone therapy: a systematic review and meta-analysis","volume":"115","author":"Tienforti","year":"2024","journal-title":"Calcif Tissue Int"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"e46609","DOI":"10.7759\/cureus.46609","article-title":"Pan-immune-inflammation index as a biomarker for rheumatoid arthritis progression and diagnosis","volume":"15","author":"Tutan","year":"2023","journal-title":"Cureus"},{"key":"ref41","first-page":"692","article-title":"Pan-immune-inflammation value at diagnosis independently predicts all-cause mortality in microscopic polyangiitis","volume":"11","author":"Lee","year":"2022","journal-title":"J Clin 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