Bone turnover markers and prediction of fracture: a prospective follow-up study of 1040 elderly women for a mean of 9 years.
Osteoporosis is characterized by compromised bone mass and strength, predisposing to an increased risk of fracture. Increased bone metabolism has been suggested to be a risk factor for fracture. The aim of this study was to evaluate whether baseline bone turnover markers are associated with long-term incidence of fracture in a population-based sample of 1040 women who were 75 years old (Malmö OPRA study). Seven bone markers (S-TRACP5b, S-CTX-I, S-OC[1-49], S-TotalOC, S-cOC, S-boneALP, and urinary osteocalcin) were measured at baseline and 1-year follow-up visit. During the mean follow-up of 9.0 years (range 7.4-10.9), 363 women sustained at least one fracture of any type, including 116 hip fractures and 103 clinical vertebral fractures. High S-TRACP5b and S-CTX-I levels were associated with increased risk of any fracture with hazard ratios [HRs (95% confidence interval)] of 1.16 (1.04-1.29) and 1.13 (1.01-1.27) per SD increase, respectively. They also were associated with increased risk of clinical vertebral fracture with HRs of 1.22 (1.01-1.48) and 1.32 (1.05-1.67), respectively. Markers were not associated with risk for hip fracture. Results were similar when we used resorption markers, including urinary osteocalcin, measured at the 1-year visit or an average of the two measurements. The HRs were highest for any fracture in the beginning of the follow-up period, 2.5 years from baseline. For vertebral fractures, the association was more pronounced and lasted for a longer period of time, at least for 5 years. In conclusion, elevated levels of S-TRACP5b, S-CTX-I, and urinary osteocalcin are associated with increased fracture risk for up to a decade in elderly women.
Ivaska
Kaisa K
KK
Clinical and Molecular Osteoporosis Research Unit, Lund University, Department of Orthopaedics, Malmö University Hospital, SE-20502 Malmö, Sweden. kaisa.ivaska@utu.fi
Gerdhem
Paul
P
Väänänen
H Kalervo
HK
Akesson
Kristina
K
Obrant
Karl J
KJ
D000368:Aged; D015415:Biomarkers / Q000097:blood* / Q000652:urine*; D015519:Bone Density; D001862:Bone Resorption / Q000150:complications / Q000378:metabolism*; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000453:epidemiology* / Q000209:etiology / Q000378:metabolism; D006620:Hip Fractures / Q000453:epidemiology / Q000209:etiology / Q000378:metabolism; D006801:Humans; D015994:Incidence; D015663:Osteoporosis, Postmenopausal / Q000150:complications; D012307:Risk Factors; D013997:Time Factors
D015415:Biomarkers