title: Plasma periostin associates significantly with non-vertebral but not vertebral fractures in postmenopausal women: Clinical evidence for the different effects of periostin depending on the skeletal site.
abstract: BACKGROUND
  Periostin is preferentially expressed by the periosteum, which mainly covers the long bones. Therefore, the role of periostin in osteoporotic fracture (OF) may differ depending on bone type. We performed a case-control study to investigate whether periostin can serve as a predictor of OF risk, particularly after dividing OFs into non-vertebral and vertebral fractures.
  
  
  METHODS
  Among 532 consecutive postmenopausal women not taking any drug or without any disease that could affect bone metabolism, 133 cases with OF (i.e., non-vertebral and/or vertebral fractures) and 133 age- and body mass index-matched controls were enrolled. Non-vertebral (i.e., forearm, humerus, hip, and pelvis; n=81) and morphological vertebral (n=62) fractures were identified by an interviewer-assisted questionnaire and lateral thoracolumbar radiographs, respectively. Bone mineral density (BMD) and plasma periostin levels were also measured.
  
  
  RESULTS
  Plasma periostin was markedly higher in subjects with non-vertebral fracture than their controls even after adjustment for BMD and potential confounders (P=0.006). Each standard deviation increment of plasma periostin was associated with a multivariable-adjusted odds ratio of 1.59 for non-vertebral fracture. The odds for non-vertebral fracture were 2.48-fold higher in subjects in the highest periostin tertile compared with those in the lowest periostin tertile (95% confidence interval=1.10-5.61). However, associations between plasma periostin and vertebral fracture were not observed, regardless of the adjustment model used. Consistently, plasma periostin levels were inversely associated with proximal femur BMD (P=0.007 to 0.030) but not lumbar spine BMD. In subgroup analyses, plasma periostin had no correlation with the levels of classical bone turnover markers.
  
  
  CONCLUSIONS
  Plasma periostin may be a potential biomarker of the risk of OF, especially in non-spinal skeletal sites, such as the limbs, rather than spine.
authors: Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Republic of Korea.
authors: Beom-Jun
authors: BJ
authors: Kim
authors: Department of Internal Medicine, Severance Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul 120-752, Republic of Korea.
authors: Yumie
authors: Y
authors: Rhee
authors: Department of Internal Medicine, Sejong General Hospital, Bucheon 422-711, Republic of Korea.
authors: Chong Hwa
authors: CH
authors: Kim
authors: Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul 137-701, Republic of Korea.
authors: Ki Hyun
authors: KH
authors: Baek
authors: Division of Endocrinology and Metabolism, Department of Internal Medicine, Sungkyunkwan University School of Medicine, Seoul 135-710, Republic of Korea.
authors: Yong-Ki
authors: YK
authors: Min
authors: Department of Nuclear Medicine, Kyunghee University School of Medicine, Seoul 130-872, Republic of Korea.
authors: Deog-Yoon
authors: DY
authors: Kim
authors: Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Republic of Korea.
authors: Seong Hee
authors: SH
authors: Ahn
authors: Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Republic of Korea.
authors: Hyeonmok
authors: H
authors: Kim
authors: Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Republic of Korea.
authors: Seung Hun
authors: SH
authors: Lee
authors: Asan Institute for Life Sciences, Seoul 138-736, Republic of Korea.
authors: Sun-Young
authors: SY
authors: Lee
authors: Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul 137-701, Republic of Korea. Electronic address: mikang@catholic.ac.kr.
authors: Moo-Il
authors: MI
authors: Kang
authors: Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Republic of Korea. Electronic address: jmkoh@amc.seoul.kr.
authors: Jung-Min
authors: JM
authors: Koh
mesh_terms: D015502:Absorptiometry, Photon; D000368:Aged; D015519:Bone Density; D001842:Bone and Bones / Q000187:drug effects*; D016022:Case-Control Studies; D015815:Cell Adhesion Molecules / Q000097:blood*; D005260:Female; D005269:Femur / Q000000981:diagnostic imaging / Q000502:physiology; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000517:prevention & control; D058866:Osteoporotic Fractures / Q000097:blood / Q000000981:diagnostic imaging / Q000517:prevention & control*; D017698:Postmenopause; D012307:Risk Factors; D016103:Spinal Fractures / Q000097:blood / Q000000981:diagnostic imaging / Q000517:prevention & control*
chemical_list: D015815:Cell Adhesion Molecules; C512835:POSTN protein, human
keywords: Bone mineral density; Non-vertebral fracture; Osteoporotic fracture; Periostin; Postmenopausal women