title: Biochemical markers for bone turnover predict risk of vertebral fractures in postmenopausal women over 10 years: the Japanese Population-based Osteoporosis (JPOS) Cohort Study.
abstract: We evaluated how bone turnover might predict vertebral fracture risk in postmenopausal women over 10 years. After adjusting for age and femoral neck bone mineral density, high bone-specific alkaline phosphatase and total and free deoxypyridinoline at baseline predicted increased vertebral fracture risk in women with ≥ 5 years since menopause.
  
  
  BACKGROUND
  The aim was to evaluate the ability of bone turnover markers (BTMs) in predicting vertebral fractures.
  
  
  METHODS
  Participants in the 1996 baseline survey of the JPOS Cohort Study included 522 postmenopausal women, with no diseases or medications affecting bone metabolism. Vertebral fractures were ascertained in three follow-up surveys (1999, 2002, and 2006). Initial fracture events were diagnosed morphometrically. The Poisson regression model was applied to estimate the rate ratio (RR) of the following log-transformed BTM values at baseline: osteocalcin and bone-specific alkaline phosphatase (BAP) in serum and C-terminal cross-linked telopeptide of type I collagen, total deoxypyridinoline (tDPD), and free deoxypyridinoline (fDPD) in urine.
  
  
  RESULTS
  Eighty-three fracture events were diagnosed over a median follow-up period of 10.0 years. RR per standard deviation (SD) (95 % confidence interval) for BAP was 4.38 (1.45, 13.21) among 65 subjects with years since menopause (YSM) < 5 years. RRs per SD (95 % confidence interval) for BAP, tDPD, and fDPD were 1.39 (1.12, 1.74), 1.32 (1.05, 1.67), and 1.40 (1.12, 1.76), respectively, after adjusting for age and femoral neck bone mineral density (FN BMD) among 457 subjects with YSM ≥ 5 years. Of the 451 women followed at least once until 2002, RRs per SD for BAP, tDPD, and fDPD adjusted for age and FN BMD over 6 years were not significantly different from those over 10 years.
  
  
  CONCLUSIONS
  BAP was associated with vertebral fracture risk among early postmenopausal women. BTMs can predict vertebral fractures independently of BMD among late postmenopausal women over a 10-year follow-up period.
authors.affiliation: Department of Public Health, Faculty of Medicine, Kinki University, 377-2 Oono-higasi, Osaka-sayama, Osaka 589-8511, Japan.
authors.forename: J
authors.initials: J
authors.lastname: Tamaki
authors.forename: M
authors.initials: M
authors.lastname: Iki
authors.forename: E
authors.initials: E
authors.lastname: Kadowaki
authors.forename: Y
authors.initials: Y
authors.lastname: Sato
authors.forename: Y
authors.initials: Y
authors.lastname: Chiba
authors.forename: T
authors.initials: T
authors.lastname: Akiba
authors.forename: T
authors.initials: T
authors.lastname: Matsumoto
authors.forename: H
authors.initials: H
authors.lastname: Nishino
authors.forename: S
authors.initials: S
authors.lastname: Kagamimori
authors.forename: Y
authors.initials: Y
authors.lastname: Kagawa
authors.forename: H
authors.initials: H
authors.lastname: Yoneshima
mesh_terms: D015502:Absorptiometry, Photon / Q000379:methods; D000293:Adolescent; D000328:Adult; D000368:Aged; D000469:Alkaline Phosphatase / Q000097:blood; D000596:Amino Acids / Q000097:blood; D015415:Biomarkers / Q000097:blood*; D015519:Bone Density / Q000502:physiology; D016723:Bone Remodeling / Q000502:physiology*; D005260:Female; D005272:Femur Neck / Q000503:physiopathology; D005500:Follow-Up Studies; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008159:Lumbar Vertebrae / Q000503:physiopathology; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D058866:Osteoporotic Fractures / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods; D016103:Spinal Fractures / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D055815:Young Adult
chemical_list: D000596:Amino Acids; D015415:Biomarkers; C036020:deoxypyridinoline; D000469:Alkaline Phosphatase