Elevated Bone Turnover Markers Are Associated With Distal Radius Fractures in Premenopausal Women.
OBJECTIVE
To examine whether premenopausal women with distal radius fractures (DRF) have lower levels of 25-hydroxyvitamin D (25[OH]D) and increased levels of serum bone turnover markers (BTM) compared with control subjects without fracture.


METHODS
Premenopausal women with DRF (n = 20) were prospectively enrolled and compared with age-matched individuals without a fracture (n = 20). Outcome measures included serum levels of 25(OH)D, parathyroid hormone (PTH), markers of bone formation (osteocalcin [OC], N-terminal extension propeptide of type I collagen [P1NP], and bone-specific alkaline phosphatase [BSAP]), and markers of bone resorption (C-terminal telopeptide of type I collagen [CTX]). We assessed associations between BTM and DRF with conditional logistic regression and the utility of markers for fracture prediction with a receiver operator characteristic analysis.


RESULTS
The fracture group and control group were comparable in terms of age at menarche and BMI. Patients who had fractures had significantly greater levels of OC and P1NP, and demonstrated a nonsignificant increase in CTX. Levels of 25(OH)D, PTH, and BSAP were similar between groups. Conditional logistic regression revealed independent associations between DRF and increased levels of OC and CTX. Levels of 25(OH)D and PTH were not associated with DRF. Receiver operator characteristic analyses demonstrated moderate performance for OC, P1NP, BSAP, and CTX in predicting DRF.


CONCLUSIONS
Levels of 25(OH)D were not associated with DRF in premenopausal women. However, patients with DRF had increased levels of BTM of formation and resorption. Bone turnover markers may be helpful in predicting future fragility fractures in premenopausal women.


METHODS
Prognostic II.
Seattle Hand Surgery Group, Seattle, WA.
Beverlie L
BL
Ting
Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Boston, MA.
Kempland C
KC
Walley
Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA.
Thomas G
TG
Travison
Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Boston, MA. Electronic address: trozenta@bidmc.harvard.edu.
Tamara D
TD
Rozental
D015502:Absorptiometry, Photon; D000293:Adolescent; D000328:Adult; D000469:Alkaline Phosphatase / Q000097:blood; D015519:Bone Density; D016723:Bone Remodeling; D024042:Collagen Type I / Q000097:blood; D005260:Female; D006801:Humans; D008875:Middle Aged; D015675:Osteocalcin / Q000097:blood; D010281:Parathyroid Hormone / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D010455:Peptides / Q000097:blood; D017697:Premenopause; D011347:Procollagen / Q000097:blood; D011446:Prospective Studies; D011885:Radius Fractures / Q000097:blood*; D012307:Risk Factors; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood
D024042:Collagen Type I; D010281:Parathyroid Hormone; D010446:Peptide Fragments; D010455:Peptides; D011347:Procollagen; C052929:collagen type I trimeric cross-linked peptide; C047202:procollagen Type I N-terminal peptide; D015675:Osteocalcin; D014807:Vitamin D; C104450:25-hydroxyvitamin D; D000469:Alkaline Phosphatase
Bone turnover markers; distal radius fracture; fragility fractures; osteoporosis; vitamin D