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J Bone Miner Res. 2018 Jul;33(7):1199-1208. doi: 10.1002/jbmr.3471. Epub 2018 Jun 19.

Bone Turnover Markers Are Not Associated With Hip Fracture Risk: A Case-Control Study in the Women's Health Initiative.

Author information

1
Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, USA.
2
Women's Health Initiative, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
3
Family and Preventive Medicine, University of California, San Diego, La Jolla, CA, USA.
4
Endocrine, Diabetes, and Hypertension Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
5
Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA.
6
Department of Medicine, UC Davis Medical Center, Sacramento, CA, USA.
7
Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, The Ohio State University, Columbus, OH, USA.
8
Departments of Medicine and Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, USA.

Abstract

Current guidelines recommend that serum C-terminal telopeptide of type I collagen (CTX) and serum procollagen type 1 aminoterminal propeptide (PINP), measured by standardized assays, be used as reference markers in observational and interventional studies. However, there are limited data to determine whether serum CTX and PINP are associated with hip fracture risk among postmenopausal women. We determined the associations of serum CTX and serum PINP with hip fracture risk among postmenopausal women aged 50 to 79 years at baseline. We performed a prospective case-control study (400 cases, 400 controls) nested in the Women's Health Initiative Observational Study, which enrolled participants at 40 US clinical centers. Cases were women with incident hip fracture not taking osteoporosis medication; hip fractures were confirmed using medical records. Untreated controls were matched by age, race/ethnicity, and date of blood sampling. Serum CTX and serum PINP were analyzed on 12-hour fasting blood samples. The main outcome measure was incident hip fracture risk (mean follow-up 7.13 years). After adjustment for body mass index, smoking, frequency of falls, history of fracture, calcium and vitamin D intake, and other relevant covariates, neither serum CTX level nor serum PINP level was statistically significantly associated with hip fracture risk (CTX ptrend  = 0.22, PINP ptrend  = 0.53). Our results do not support the utility of serum CTX level or PINP level to predict hip fracture risk in women in this age group. These results will inform future guidelines regarding the potential utility of these markers in fracture prediction.

KEYWORDS:

BONE TURNOVER; C-TERMINAL TELOPEPTIDE OF TYPE I COLLAGEN; CTX; FRACTURE; PINP; PROCOLLAGEN TYPE 1 AMINOTERMINAL PROPEPTIDE

PMID:
29923225
DOI:
10.1002/jbmr.3471

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