Article :: Bone turnover markers and prediction of fracture A prospective followup study of 1040 elderly women for a mean of 9 years

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Original Article

Bone turnover markers and prediction of fracture: A prospective follow-up study of 1040 elderly women for a mean of 9 years

Kaisa K Ivaska^{1 2 *}, Paul Gerdhem^{1 3}, H Kalervo Väänänen², Kristina Åkesson¹, Karl J Obrant¹

¹Clinical and Molecular Osteoporosis Research Unit, Lund University, Department of Orthopaedics, Malmö University Hospital, SE-20502 Malmö, Sweden
²University of Turku, Institute of Biomedicine, Department of Cell Biology and Anatomy, FI-20520 Turku, Finland
³Department of Clinical Science, Intervention and Technology, Karolinska Institute, and Department of Orthopaedics, Karolinska University Hospital, SE-14186 Stockholm, Sweden

email: Kaisa K Ivaska (kaisa.ivaska@utu.fi)

^*Correspondence to Kaisa K Ivaska, University of Turku, Institute of Biomedicine, Department of Cell Biology and Anatomy, Turku, FI-20520, Finland.

Keywords

bone turnover markers osteoporotic fracture longitudinal prospective TRACP5b

Abstract

Osteoporosis is characterized by compromised bone mass and strength, predisposing to an increased risk of fracture. Increased bone metabolism has been suggested to be a risk factor for fracture. The aim of this study was to evaluate whether baseline bone turnover markers are associated with long-term incidence of fracture in a population-based sample of 1040 women who were 75 years old (Malmö OPRA study). Seven bone markers (S-TRACP5b, S-CTX-I, S-OC[1-49], S-TotalOC, S-cOC, S-boneALP, and urinary osteocalcin) were measured at baseline and 1-year follow-up visit. During the mean follow-up of 9.0 years (range 7.4-10.9), 363 women sustained at least one fracture of any type, including 116 hip fractures and 103 clinical vertebral fractures. High S-TRACP5b and S-CTX-I levels were associated with increased risk of any fracture with hazard ratios [HRs (95% confidence interval)] of 1.16 (1.04-1.29) and 1.13 (1.01-1.27) per SD increase, respectively. They also were associated with increased risk of clinical vertebral fracture with HRs of 1.22 (1.01-1.48) and 1.32 (1.05-1.67), respectively. Markers were not associated with risk for hip fracture. Results were similar when we used resorption markers, including urinary osteocalcin, measured at the 1-year visit or an average of the two measurements. The HRs were highest for any fracture in the beginning of the follow-up period, 2.5 years from baseline. For vertebral fractures, the association was more pronounced and lasted for a longer period of time, at least for 5 years. In conclusion, elevated levels of S-TRACP5b, S-CTX-I, and urinary osteocalcin are associated with increased fracture risk for up to a decade in elderly women. © 2010 American Society for Bone and Mineral Research

Received: 17 May 2009; Revised: 17 August 2009; Accepted: 9 October 2009

Digital Object Identifier (DOI)

10.1359/jbmr.091006 About DOI