Serum osteocalcin and procollagen as markers for the risk of osteoporotic fracture in corticosteroid-treated asthmatic adults.
BACKGROUND
Dual energy x-ray absorptiometry provides the definitive measure of osteoporotic fracture risk.


OBJECTIVE
We sought to determine whether metabolic measures of bone formation and/or common features of clinical hypercortisonism provide a useful guide in selecting corticosteroid-treated asthmatic patients for referral for bone densitometry.


METHODS
We measured bone density and 8 AM serum osteocalcin, procollagen, and cortisol levels in 52 asthmatic adults aged 60.7 +/- 12.6 years (mean +/- SD). Years of steroid exposure for these patients was 11.8 +/- 10.7 (prednisone) and 11.78 +/- 4.98 (inhaled steroid). Using stepwise logistic regression, we assessed the capacity of the osteocalcin and procollagen levels, with or without the cortisol level, age, clinical features of hypercortisonism, and different lifetime exposures to inhaled and oral steroids for distinguishing between patients with greater or lesser risk of fracture.


RESULTS
Osteoporosis, defined as a bone density T score below -2.5, affected 26% of the group at the spine and 63% at the hip. At the spine, greater risk was associated only with lower cortisol levels (P =.003). Diagnostic accuracy was 71%, the false-positive rate was 26%, and the false-negative rate was 31%. At the hip, greater risk was associated with lower cortisol levels (P =.002), longer prednisone exposure, (P =.003), lower current doses of prednisone (P =.01) and inhaled steroid (P =.02), and older age (P =.01). Diagnostic accuracy was 83%, the false-positive rate was 13%, and the false-negative rate was 21%.


CONCLUSIONS
Neither osteocalcin nor procollagen nor any of the clinical criteria analyzed proved sufficiently accurate to be reliable as indicators of the risk of fracture in these elderly, corticosteroid-treated asthmatic adults. They are therefore not useful for selecting such patients for diagnostic densitometry.
Toogood
J H
JH
Department of Medicine, University of Western Ontario, London, Canada.
Hodsman
A B
AB
Fraher
L J
LJ
Markov
A E
AE
Baskerville
J C
JC
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D001249:Asthma / Q000150:complications* / Q000188:drug therapy; D015415:Biomarkers; D005069:Evaluation Studies as Topic; D005260:Female; D050723:Fractures, Bone / Q000209:etiology*; D006620:Hip Fractures / Q000209:etiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015675:Osteocalcin / Q000097:blood*; D010024:Osteoporosis / Q000150:complications*; D011347:Procollagen / Q000097:blood*; D012307:Risk Factors; D016103:Spinal Fractures / Q000209:etiology
D000305:Adrenal Cortex Hormones; D015415:Biomarkers; D011347:Procollagen; D015675:Osteocalcin