Study summarizes fracture prediction strength of reference bone turnover markers

A new study by an International Osteoporosis Foundation (IOF) and International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) scientific working group summarizes the clinical performance of serum procollagen type I N propeptide (s-PINP) and serum C-terminal cross-linking telopeptide of type I collagen (s-CTX) in fracture risk prediction in untreated individuals in prospective cohort studies.

The current study follows a position paper published in 2011 by the IOF-IFCC Bone Marker Standards Working Group recommending the use of bone formation marker serum s-PINP and bone resorption marker serum s-CTX as reference markers to be used in future studies of .

In the study, ten potentially eligible publications were identified and six included in meta-analysis. The results showed a moderate but significant association between the (BTMs) studied and the risk of future fractures not adjusted for (BMD). There was a significant association between s-PINP and the risk of fracture. The hazard ratio (HR) per standard deviation (SD) increase in s-PINP was 1.23 (95% CI: 1.09-1.39) for men and women combined unadjusted for bone . There was also a significant association between s-CTX and risk of fracture, HR per SD 1.18 (95% CI: 1.05-1.34) unadjusted for density. For the outcome of hip fracture, the association between s-CTX and risk of fracture was slightly higher 1.23 (95% CI: 1.04-1.47).

"This is the first meta-analysis of BTMs which was made possible by standardising the expression of risk," said Working Group Co-Chair Professor Howard A. Morris, School of Pharmacy and Medical Sciences, University of South Australia. He added, "One strength of the study is that we were able to standardize the metric of predictive power. The metric used was the gradient of risk – namely the increase in fracture hazard ratio between two individuals who differ by 1SD in BTM. This has the advantage of maximizing the use that can be made of publications that used differing indices of risk."

The increased by approximately 20%, depending on the analyte and the outcome fracture that was studied. These gradients of risk are substantially lower than those reported for the use of femoral neck BMD in the prediction of fracture.

Professor John A. Kanis, IOF President and report author said, "More studies are required to better evaluate the independent role of BTMs in fracture risk prediction. The use of common reference BTMs in prospective cohort studies with the standardization of their measurements, as recommended by the IOF and the IFCC, will help address these important issues."

More information: Johansson H, Odén A1, Kanis JA, McCloskey EV, Morris HA, Cooper C, Vasikaran S and the IFCC-IOF Joint Working Group on standardisation of biochemical markers of bone turnover. A meta-analysis of reference markers of bone turnover for prediction of fracture. Calcif Tissue Int, DOI: 10.1007/s00223-014-9842-y

Related paper:

Vasikaran S, Eastell R, Bruyere O, Foldes AJ, Garnero P, Griesmacher A, McClung M, Morris HA, Silverman S, Trenti T, Wahl DA, Cooper C, Kanis JA; IOF-IFCC Bone Marker Standards Working Group. Markers of bone turnover for the prediction of fracture risk and monitoring of osteoporosis treatment: a need for international reference standards. Osteoporos Int 2011;22(2):391-420. link.springer.com/article/10.1… 07/s00198-010-1501-1

add to favorites email to friend print save as pdf

Related Stories

Wrist fracture significantly raises risk of hip fracture

Dec 13, 2013

A new study presented today at the IOF Regionals 4th Asia-Pacific Osteoporosis Meeting in Hong Kong supports widespread evidence that individuals who have suffered a fracture are at significantly increased risk of subsequent ...

Body fat linked to reduced fracture risk for women

May 02, 2012

(HealthDay) -- Higher body fat mass is associated with a reduced risk of fracture among women, but not men, according to a study published in the May issue of the Journal of Internal Medicine.

Recommended for you

Ebola mistakes should serve a lesson says WHO

6 hours ago

The World Health Organization's chief admitted on Sunday that the UN agency had been caught napping on Ebola, saying it should serve as a lesson to avoid similar mistakes in future.

British Ebola nurse discharged from hospital

12 hours ago

A British nurse who contracted Ebola while working as a volunteer in Sierra Leone said she was "happy to be alive" as she was discharged from hospital on Saturday having made a full recovery.

Tide turning in Ebola fight after hard lessons

Jan 24, 2015

A top U.N. official in the fight against Ebola greeted just three patients at one treatment center he visited this week in Sierra Leone. Families in Liberia are no longer required to cremate the remains of ...

Just five Ebola cases left in Liberia: UN

Jan 24, 2015

The United Nations said on Saturday Liberia was dealing with just five remaining cases of Ebola, in the clearest sign yet that the country is nearing the end of the outbreak.

User comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.