Original Article

Osteoporosis International

, Volume 17, Issue 7, pp 1086-1095

First online:

Biochemical markers of bone turnover predict bone loss in perimenopausal women but not in postmenopausal women-the Japanese Population-based Osteoporosis (JPOS) Cohort Study

  • M. IkiAffiliated withDepartment of Public Health, Kinki University School of Medicine Email author 
  • , A. MoritaAffiliated withDepartment of Public Health, Kinki University School of Medicine
  • , Y. IkedaAffiliated withDepartment of Public Health, Kinki University School of Medicine
  • , Y. SatoAffiliated withDepartment of Nutrition, School of Nutrition and Nursing, Tenshi College
  • , T. AkibaAffiliated withDepartment of Blood Purification and Internal Medicine, Kidney Center, Tokyo Women’s Medical University
  • , T. MatsumotoAffiliated withDepartment of Medicine and Bioregulatory Sciences, University of Tokushima Graduate School of Health Biosciences
  • , H. NishinoAffiliated withToyama Red Cross Blood Center
  • , S. KagamimoriAffiliated withDepartment of Welfare Promotion and Epidemiology, Faculty of Medicine, University of Toyama
  • , Y. KagawaAffiliated withKagawa Nutrition University
    • , H. Yoneshima ·Affiliated withShuuwa General Hospital
    • , For the JPOS Study Group

Rent the article at a discount

Rent now

* Final gross prices may vary according to local VAT.

Get Access



The predictive value of biochemical markers of bone turnover for subsequent change in bone density in a population sample of healthy women with a wide range of ages has not been fully established.


We followed 1,283 women aged 15–79 years at baseline selected randomly from the inhabitants of three areas in Japan for 6 years, and examined 1,130 subjects with no disease or administration of drugs affecting bone metabolism. The annual change in bone density at the spine, total hip, and distal one third of the radius was determined during the follow-up period by dual x-ray absorptiometry and was compared among the groups using different levels of biochemical markers at baseline, including serum osteocalcin (OC) and bone-specific alkaline phosphatase (bone ALP), free and total (tDPD) forms of immunoreactive deoxypyridinoline, and type I collagen crosslinked C-terminal telopeptide (CTX) in urine.


Premenopausal women aged 45 years or older with elevated levels of OC, bone ALP, CTX, or tDPD showed significantly greater bone loss at most skeletal sites during the follow-up period than those with lower levels, after adjustment for the effects of age, height, weight, dietary calcium intake, regular exercise, and current smoking. The greatest coefficient of determination of the model was observed in the association between CTX and bone loss at the hip during the first 3 years of follow-up (42.8%). These subjects were pooled with perimenopausal women at baseline, and those who still menstruated at follow-up in this pooled group showed significant but more modest associations, whereas those who entered menopause during the follow-up period showed clear associations. However, early postmenopausal women with less than 5 or 10 years since menopause showed an association that was limited mostly to the distal radius, and other postmenopausal groups had virtually no association.


Biochemical markers of bone turnover may predict bone loss in women undergoing menopausal transition but may not predict bone loss in postmenopausal women.


Bone mineral density Bone turnover markers Japanese women Longitudinal study Population-based epidemiologic study Random sample