title: Is the predictive power of previous fractures for new spine and non-spine fractures associated with biochemical evidence of altered bone remodelling? The EPOS study. European Prospective Osteoporosis Study.
abstract: BACKGROUND
  In the European Prospective Osteoporosis Study (EPOS), a past spine fracture increased risk of an incident fracture 3.6 - 12-fold even after adjusting for BMD. We examined the possibility that biochemical marker levels were associated with this unexplained BMD-independent element of fracture risk.
  
  
  METHODS
  Each of 182 cases in EPOS of spine or non-spine fracture that occurred in 3.8 years of follow-up was matched by age, sex and study centre with two randomly assigned never-fractured controls and one case of past fracture. Analytes measured blind were: osteocalcin, bone-specific alkaline phosphatase, total alkaline phosphatase, serum creatinine, calcium, phosphate and albumin, together with the collagen cross-links degradation products serum CTS and urine CTX. Most subjects also had bone density measured by DXA.
  
  
  RESULTS
  Cases who had recent fractures did not differ in marker levels from cases who had their last fracture more than 3 years previously. No statistically significant effect of recent fracture was found for any marker except osteocalcin, which was 17.6% lower in recent peripheral cases compared to unfractured controls (p<0.05) and this was independent of BMD.
  
  
  CONCLUSIONS
  Past fracture as a risk indicator for future fracture is not strongly mediated through increased bone turnover.
authors.affiliation: U. INSERM 403, Lyon, France.
authors.forename: P
authors.initials: P
authors.lastname: Vergnaud
authors.forename: M
authors.initials: M
authors.lastname: Lunt
authors.forename: C
authors.initials: C
authors.lastname: Scheidt-Nave
authors.forename: G
authors.initials: G
authors.lastname: Poor
authors.forename: C
authors.initials: C
authors.lastname: Gennari
authors.forename: K
authors.initials: K
authors.lastname: Hoszowski
authors.forename: A Lopes
authors.initials: AL
authors.lastname: Vaz
authors.forename: D M
authors.initials: DM
authors.lastname: Reid
authors.forename: L
authors.initials: L
authors.lastname: Benevolenskaya
authors.forename: S
authors.initials: S
authors.lastname: Grazio
authors.forename: K
authors.initials: K
authors.lastname: Weber
authors.forename: T
authors.initials: T
authors.lastname: Miazgowski
authors.forename: J J
authors.initials: JJ
authors.lastname: Stepan
authors.forename: P
authors.initials: P
authors.lastname: Masaryk
authors.forename: F
authors.initials: F
authors.lastname: Galan
authors.forename: J Bruges
authors.initials: JB
authors.lastname: Armas
authors.forename: R
authors.initials: R
authors.lastname: Lorenc
authors.forename: S
authors.initials: S
authors.lastname: Havelka
authors.forename: R
authors.initials: R
authors.lastname: Perez Cano
authors.forename: M
authors.initials: M
authors.lastname: Seibel
authors.forename: G
authors.initials: G
authors.lastname: Armbrecht
authors.forename: S
authors.initials: S
authors.lastname: Kaptoge
authors.forename: T W
authors.initials: TW
authors.lastname: O'Neill
authors.forename: A J
authors.initials: AJ
authors.lastname: Silman
authors.forename: D
authors.initials: D
authors.lastname: Felsenberg
authors.forename: J
authors.initials: J
authors.lastname: Reeve
authors.forename: P D
authors.initials: PD
authors.lastname: Delmas
mesh_terms: D000368:Aged; D000375:Aging; D000469:Alkaline Phosphatase / Q000378:metabolism; D015415:Biomarkers / Q000032:analysis; D015519:Bone Density / Q000502:physiology; D016723:Bone Remodeling; D002118:Calcium / Q000032:analysis; D003094:Collagen / Q000378:metabolism; D003404:Creatinine / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000150:complications* / Q000175:diagnosis / Q000209:etiology / Q000378:metabolism*; D006801:Humans; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D015675:Osteocalcin / Q000032:analysis; D010710:Phosphates / Q000032:analysis; D011379:Prognosis; D012008:Recurrence; D012727:Sex Characteristics; D016103:Spinal Fractures / Q000150:complications* / Q000175:diagnosis / Q000209:etiology / Q000378:metabolism*; D014807:Vitamin D / Q000032:analysis
chemical_list: D015415:Biomarkers; D010710:Phosphates; D015675:Osteocalcin; D014807:Vitamin D; D003094:Collagen; D003404:Creatinine; D000469:Alkaline Phosphatase; D002118:Calcium