Rapid Bone Loss Is Associated with Increased Levels of Biochemical Markers

Abstract

We examined associations of biochemical markers of bone turnover with rapid bone loss, as measured by changes in bone mineral density (BMD). To improve the precision of bone loss estimates, calcaneal BMD was measured up to eight times over a long interval (13 years) among postmenopausal women (mean age ‫؍‬ 62 years at baseline). Women with fractures during the previous year, and users of corticosteroids, active vitamin D, bisphosphonates or calcitonin were excluded to avoid potential transient effects on marker levels. Among the remaining 354 women, markers were measured for 100 women with the fastest BMD loss (rapid loss group; mean ‫؍‬ 2.2%/year) and 100 with the slowest loss (mean ‫؍‬ 0.4%/year). Two markers of bone formation, serum bone alkaline phosphatase (Alkphase-B; BAP) and osteocalcin (NovoCalcin; OC), and two markers of bone resorption, urinary creatininecorrected free deoxypyridinoline (Pyrilinks-D; DPD) and free pyridinolines (Pyrilinks; PYD), were measured. In separate logistic regression models, each of the markers was strongly associated with rapid loss: the odds of rapid loss increased by 1.8 to 2.0 times for each 1.0 standard deviation (SD) increase of the marker. For BAP levels 2 SD above the mean, the probability of rapid bone loss was 80%; in contrast, the probability was only 20% at 2 SD below the mean. The other markers yielded similar results. We conclude that these markers are associated with rapid bone loss; this relationship appears to be continuous, with progressively greater risk of rapid bone loss with increasing levels of biomarkers. Prospective studies that include the entire distribution of bone loss rates are warranted to confirm these findings. (J Bone Miner Res 1998;13:297-302)

Bone Resorption in Post-menopausal Women with Normal and Low BMD Assessed with Biochemical Markers Specific for Telopeptide Derived Degradation Products of Collagen Type I

“…These results are in accordance with previous studies reporting correlation coefficients slightly lower or in the same range as those observed in the present investigation [16,17,21,22,30]. Interestingly, the ␣/␤ CTx ratio showed relatively poor correlations with the individual bone resorption markers.…”

“…These markers have been extensively used for both the assessment of therapeutic efficacy of antiresorptive drugs in osteoporosis and for prediction of fracture risk in postmenopausal women [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. We measured urinary and serum CTx and urinary NTx in a large cohort of untreated, healthy women stratified on the basis of their menopausal status and BMD.…”

“…Bone markers might also be used to prognose a high rate of bone less in postmenopausal women who would subsequently develop osteoporosis and fractures [16][17][18][19][20][21][22][23][24][25]. Bone turnover increases after menopause and remains elevated in late postmenopausal women.…”

“…Thus, biochemical markers of bone turnover provide a rapid assessment of the effects of antiresorptive therapies such as hormone replacement therapy, bisphosphonates, and calcitonin which induce a decrease in the levels of bone markers that is correlated with the long-term effect of such treatments on bone mass [5][6][7][8][9][10][11][12][13][14][15]. Due to the small annual changes in BMD, the effect of antiresorptive therapy can only be reliably monitored by BMD measurement after several years followup [5,10,13].Bone markers might also be used to prognose a high rate of bone less in postmenopausal women who would subsequently develop osteoporosis and fractures [16][17][18][19][20][21][22][23][24][25]. Bone turnover increases after menopause and remains elevated in late postmenopausal women.…”

Calcium metabolism and vitamin D in the extreme longevity

“…However, it is evident a disequilibrium of these two processes, with a prevalence of bone resorption, especially in the elderly (Passeri, 1991;Marcus et al, 1995;Martini and Passeri, 2000;Sambrook et al, 2006). It has been demonstrated, above the age of 60 years, a clear prevalence of bone resorption, while bone formation is of varying extent, even if several metabolic parameters (e.g., serum osteocalcin) are also increased (Ross and Knowlton, 1998). Some changes characterizing aging at the cellular level, are due to a reduced numbers of fully functional cells, accompanied by impaired matrix production, cellular composition, and bone micro-environments, and altered responses to the environment (Carrington, 2005).…”