title: Higher serum carcinoembryonic antigen levels associate with more frequent development of incident fractures in Korean women: a longitudinal study using the national health insurance claim data.
abstract: BACKGROUND
  Pro-inflammatory cytokines play important roles in bone metabolism and several studies have shown that carcinoembryonic antigen (CEA) may promote inflammation. We investigated the association of serum CEA levels with the risk of osteoporosis and incident fracture.
  
  
  METHODS
  We performed a small cross-sectional study with 302 Korean women and a large, longitudinal study with 7192 Korean women in an average 3-year follow-up period. For the cross-sectional study, bone mineral density (BMD) and bone turnover markers (BTMs) were measured. For the longitudinal study, incident fractures in the follow-up period were identified by using the selected International Classification of Diseases, 10th revision (ICD-10) codes and the nationwide claims database of the Health Insurance Review and Assessment Service of Korea.
  
  
  RESULTS
  In the cross-sectional study, serum CEA levels correlated negatively with BMD at the lumbar spine (γ=-0.023; P=0.029) and positively with BTMs (γ=0.122 to 0.138, P=0.002 to P<0.001) after adjustment for confounding variables. In the longitudinal study, 254 (3.5%) women developed incident fractures in the follow-up period (2.8±1.3 years). After adjustment for potential confounders, the hazard ratio (HR) per 1 ng/mL increment of the baseline CEA level for the development of incident fracture was 1.22 [95% confidence interval (CI): 1.05-1.42]. The HR was markedly higher in subjects in the highest CEA quartile category compared with those in the lowest CEA quartile category (HR=1.54, 95% CI: 1.04-2.28).
  
  
  CONCLUSIONS
  Therefore, serum CEA may be a biomarker of the risk of incident fracture in postmenopausal Korean women.
authors.affiliation: Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, 138-736 Seoul, Republic of Korea.
authors.forename: Beom-Jun
authors.initials: BJ
authors.lastname: Kim
authors.affiliation: Department of Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, 138-736 Seoul, Republic of Korea.
authors.forename: Seunghee
authors.initials: S
authors.lastname: Baek
authors.affiliation: Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, 138-736 Seoul, Republic of Korea. Electronic address: hun0108@amc.seoul.kr.
authors.forename: Seung Hun
authors.initials: SH
authors.lastname: Lee
authors.affiliation: Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, 138-736 Seoul, Republic of Korea.
authors.forename: Seong Hee
authors.initials: SH
authors.lastname: Ahn
authors.affiliation: Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, 138-736 Seoul, Republic of Korea.
authors.forename: Hyeon-Mok
authors.initials: HM
authors.lastname: Kim
authors.affiliation: Department of Nursing, College of Medicine, Dankook University, 330-715 Cheonan, Republic of Korea.
authors.forename: Seon Ha
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Department of Preventive Medicine, Asan Medical Center, University of Ulsan College of Medicine, 138-736 Seoul, Republic of Korea.
authors.forename: Min-Woo
authors.initials: MW
authors.lastname: Jo
authors.affiliation: Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, 138-736 Seoul, Republic of Korea.
authors.forename: Sung Jin
authors.initials: SJ
authors.lastname: Bae
authors.affiliation: Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, 138-736 Seoul, Republic of Korea.
authors.forename: Hong-Kyu
authors.initials: HK
authors.lastname: Kim
authors.affiliation: Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, 138-736 Seoul, Republic of Korea.
authors.forename: Jaewon
authors.initials: J
authors.lastname: Choe
authors.affiliation: Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, 138-736 Seoul, Republic of Korea.
authors.forename: Gyung-Min
authors.initials: GM
authors.lastname: Park
authors.affiliation: Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, 138-736 Seoul, Republic of Korea.
authors.forename: Young-Hak
authors.initials: YH
authors.lastname: Kim
authors.affiliation: Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, 138-736 Seoul, Republic of Korea.
authors.forename: Ghi Su
authors.initials: GS
authors.lastname: Kim
authors.affiliation: Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, 138-736 Seoul, Republic of Korea.
authors.forename: Jung-Min
authors.initials: JM
authors.lastname: Koh
mesh_terms: D015415:Biomarkers / Q000097:blood*; D015519:Bone Density; D002272:Carcinoembryonic Antigen / Q000097:blood*; D003430:Cross-Sectional Studies; D005260:Female; D050723:Fractures, Bone / Q000097:blood* / Q000453:epidemiology; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D009313:National Health Programs; D056910:Republic of Korea / Q000453:epidemiology; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D002272:Carcinoembryonic Antigen
keywords: Bone mineral density; Carcinoembryonic antigen; Fracture; Inflammation