title: Association of bone turnover markers with mortality in women referred to coronary angiography: the Ludwigshafen Risk and Cardiovascular Health (LURIC) study.
abstract: We examined the association of fatal events with beta-crosslaps (β-CTX) and osteocalcin (OC) concentrations in women. We observed an independent association of β-CTX and OC concentrations with fatal events in women at high to intermediate cardiovascular risk.
  
  
  BACKGROUND
  There is some evidence suggesting an association of β-CTX and OC with fatal events in men and frail elderly subjects. We aimed to examine the association of fatal events with β-CTX and OC in women.
  
  
  METHODS
  We measured β-CTX and OC in 986 women aged 65 (58-72) years referred to coronary angiography.
  
  
  RESULTS
  Compared to the first β-CTX quartile, the crude hazard ratios (HRs) for all-cause and cardiovascular mortality in the highest β-CTX quartile were 2.50 (1.65-3.81) and 3.28 (1.82-5.91), respectively. In multivariate adjusted models, HRs for all-cause and cardiovascular mortality in the highest β-CTX quartile were 1.72 (1.09-2.70) and 2.31 (1.24-4.32), respectively. The lowest 25-hydroxyvitamin D [25(OH)D] quartile was significantly associated with increased risk of all-cause and cardiovascular mortality in multivariate adjusted models. In those models, the highest β-CTX quartile was associated with an increased risk of all-cause and cardiovascular mortality. For OC concentrations, we found a reverse J-shaped association with noncardiovascular mortality. Using the first quartile as reference, crude and multivariate adjusted HRs for noncardiovascular mortality in the second and third OC quartile were 0.41 (0.19-0.90) [multivariate: 0.40 (0.18-0.88)] and 0.51 (0.25-1.06) [multivariate: 0.43 (0.20-0.94)], respectively. The lowest 25(OH)D quartile was associated with a trend towards increased risk of noncardiovascular mortality in multivariate analysis. In that analysis, OC quartile 2 and 3 were significantly associated with lower risk of noncardiovascular mortality.
  
  
  CONCLUSIONS
  We observed an independent association of high β-CTX with all-cause and cardiovascular mortality and a reverse J-shaped association of OC with noncardiovascular mortality.
authors.affiliation: Department of Internal Medicine, Division of Endocrinology and Metabolism, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria, elisabeth.lerchbaum@medunigraz.at.
authors.forename: E
authors.initials: E
authors.lastname: Lerchbaum
authors.forename: V
authors.initials: V
authors.lastname: Schwetz
authors.forename: S
authors.initials: S
authors.lastname: Pilz
authors.forename: B O
authors.initials: BO
authors.lastname: Boehm
authors.forename: W
authors.initials: W
authors.lastname: März
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D016723:Bone Remodeling / Q000502:physiology*; D002318:Cardiovascular Diseases / Q000097:blood / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology*; D003094:Collagen / Q000097:blood; D017023:Coronary Angiography; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015675:Osteocalcin / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood; D011446:Prospective Studies
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C110762:glutamyl-lysyl-alanyl-histidyl-aspartyl-glycyl-glycyl-arginine; D015675:Osteocalcin; D003094:Collagen