title: Serial assessment of serum bone metabolism markers identifies women with the highest rate of bone loss and osteoporosis risk.
abstract: BACKGROUND
  One of the important challenges in the management of osteoporosis is to identify women who are at high risk of developing osteoporosis and fragility fractures.
  
  
  OBJECTIVE
  Our objective was to evaluate whether assessment of bone metabolism at multiple occasions can identify women with the highest risk for bone loss.
  
  
  METHODS
  The Malmö Osteoporosis Prospective Risk Assessment study is an ongoing longitudinal study. Participants have been evaluated at baseline and after 1, 3, and 5 yr.
  
  
  METHODS
  We conducted a population-based study.
  
  
  METHODS
  Participants included 1044 women, all 75 yr old at baseline.
  
  
  METHODS
  Seven bone turnover markers were assessed at baseline and at 1, 3, and 5 yr (n = 573). The 5-yr change in areal bone mineral density (aBMD) was also determined.
  
  
  RESULTS
  Baseline markers correlated weakly to change in total body aBMD. The associations were more pronounced when the average of the baseline and 1-yr measurements was used (standardized regression coefficients -0.12 to -0.23, P < 0.01). Adding the 3-yr and 5-yr measurement further strengthened the correlation (regression coefficients up to -0.30, P < 0.001). Women with constantly high turnover lost significantly more bone at total body assessment (-2.6%) than women with intermediate (-1.6%) or low turnover (-0.2%, P for trend < 0.001). They also had a greater decrease in hip BMD (-8.3, -6.0, and -5.1%, respectively, P = 0.010). Results were similar also in the subgroup of women with osteopenia.
  
  
  CONCLUSIONS
  Our results suggest that serial assessment of bone turnover improves the identification of women with the highest rate of bone loss and osteoporosis risk.
authors.affiliation: Clinical and Molecular Osteoporosis Research Unit, Department of Orthopaedics, Malmö University Hospital, Malmö, Sweden. kaisa.ivaska@med.lu.se
authors.forename: Kaisa K
authors.initials: KK
authors.lastname: Ivaska
authors.forename: Janaka
authors.initials: J
authors.lastname: Lenora
authors.forename: Paul
authors.initials: P
authors.lastname: Gerdhem
authors.forename: Kristina
authors.initials: K
authors.lastname: Akesson
authors.forename: H Kalervo
authors.initials: HK
authors.lastname: Väänänen
authors.forename: Karl J
authors.initials: KJ
authors.lastname: Obrant
mesh_terms: D000368:Aged; D015415:Biomarkers; D015519:Bone Density; D001851:Bone Diseases, Metabolic / Q000175:diagnosis*; D016723:Bone Remodeling; D001842:Bone and Bones / Q000378:metabolism*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D015663:Osteoporosis, Postmenopausal / Q000175:diagnosis*
chemical_list: D015415:Biomarkers