Biochemical Markers of Bone Metabolism and Prediction of Fracture in Elderly Women

Abstract

We studied the ability of various markers of bone turnover to predict fracture in 1040 randomly recruited 75-year-old women. A total of 178 of the women sustained at least one fracture during follow-up (mean, 4.6 years). In elderly women, TRACP5b and urinary fragments of osteocalcin are promising new markers for prediction of fracture, in particular, vertebral fracture.Introduction: Biochemical markers reflecting bone turnover may improve the prediction of fractures. Materials and Methods: The ability of 10 markers of bone turnover to predict fracture in 1040 elderly women in the Malmö OPRA study was studied. Serum bone-specific alkaline phosphatase and four different forms of serum osteocalcin (S-OC) were analyzed as markers of bone formation and serum C-terminal cross-linking telopeptides of type I collagen (S-CTX), serum TRACP isoform 5b (S-TRACP5b) and urinary free deoxypyridinoline (U-DPD) as markers of bone resorption. Two novel assays for osteocalcin fragments in urine (U-OC) were analyzed. Areal BMD (aBMD) was measured by DXA in the femoral neck and lumbar spine. Results: In total, 231 fractures were sustained by 178 of the women during a 3-to 6.5-year (mean, 4.6 years) follow-up period. When women with prospective fractures were compared with women without fractures, S-TRACP5b, S-CTX, one S-OC, and one U-OC were higher in women with a fracture of any type (all p Ͻ 0.05), and all bone markers were higher in women with clinical vertebral fracture (all p Ͻ 0.05). Markers were not significantly elevated in women with hip fracture. When women within the highest quartile of a bone marker were compared with all others, S-TRACP5b and one U-OC predicted the occurrence of a fracture of any type (odds ratio [OR]), 1.55 and 1.53; p Ͻ 0.05). S-TRACP5b, the two U-OCs, and S-CTX predicted vertebral fracture (OR, 2.28, 2.75, 2.71, and 1.94, respectively; all p Ͻ 0.05), and the predictive value remained significant for S-TRACP5b and the two U-OCs after adjusting for aBMD (OR, 2.02-2.25; p Ͻ 0.05). Bone markers were not able to predict hip fracture. Conclusion: These results show that biochemical markers of bone turnover can predict fracture, and in particular, fractures that engage trabecular bone. S-TRACP5b and U-OC are promising new markers for prediction of fracture.

Comparison Of Bone Turnover Markers In Gingival Crevicular Fluid Of Elderly Individuals With Different Periodontal Diseases

“…19 In elderly women, Gerdhem et al showed higher serum OC levels, whereas Garnero et al showed similar levels in postmenopausal women. 20,21 The present study showed that OC levels in all geriatric groups were similar. Several studies have found that GCF OC levels were not correlated with periodontal status; our results were in agreement with this.…”

Discriminants of Prevalent Fractures in Chronic Kidney Disease

“…34 BTMs also predicted fractures that occurred up to 6.5 years in the future. 12 Moreover, a past history of fragility fracture is a marker of overall poor bone quality and an important risk factor for future fracture, as evidenced by inclusion of this historical feature in the WHO FRAX. 15 Although our data suggest that a combination of BTMs, FN BMD, and a history of fracture may be useful to identify CKD patients who might benefit from fracture prevention strategies, prospective studies are needed to assess the utility of these parameters for fracture prediction in the CKD population.…”

“…Bone remodeling can also be assessed with reasonable accuracy by measurement of bone turnover markers (BTMs) in patients with normal kidney function. 12,13 Certain BTMs, including osteocalcin and the C-terminal telopeptides of type I collagen (CTX), are renally cleared. Others, such as bone-specific alkaline phosphatase (BSAP), procollagen type-1 N-terminal propeptide (P1NP), and tartrate-resistant acid phosphatase-5b (Trap-5b), are metabolized by nonrenal mechanisms.…”

The clinical contribution of cortical porosity to fragility fractures

“…36 There are modest but significant associations of BTM with fracture in women and men. [43][44][45][46] Still, there have been uncertainties over the use of BTM in routine clinical practice to assess fracture risk because of inter-and intra-individual variability. 47,48 Although a recent study suggested that BTM also reflect cortical bone architecture in addition to fracture risk, 31 further studies are needed to evaluate the independent role of BTM in fracture risk prediction.…”