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Biochemical markers for bone turnover predict risk of vertebral fractures in postmenopausal women over 10 years: the Japanese Population-based Osteoporosis (JPOS) Cohort Study

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Abstract

Summary

We evaluated how bone turnover might predict vertebral fracture risk in postmenopausal women over 10 years. After adjusting for age and femoral neck bone mineral density, high bone-specific alkaline phosphatase and total and free deoxypyridinoline at baseline predicted increased vertebral fracture risk in women with ≥ 5 years since menopause.

Introduction

The aim was to evaluate the ability of bone turnover markers (BTMs) in predicting vertebral fractures.

Methods

Participants in the 1996 baseline survey of the JPOS Cohort Study included 522 postmenopausal women, with no diseases or medications affecting bone metabolism. Vertebral fractures were ascertained in three follow-up surveys (1999, 2002, and 2006). Initial fracture events were diagnosed morphometrically. The Poisson regression model was applied to estimate the rate ratio (RR) of the following log-transformed BTM values at baseline: osteocalcin and bone-specific alkaline phosphatase (BAP) in serum and C-terminal cross-linked telopeptide of type I collagen, total deoxypyridinoline (tDPD), and free deoxypyridinoline (fDPD) in urine.

Results

Eighty-three fracture events were diagnosed over a median follow-up period of 10.0 years. RR per standard deviation (SD) (95 % confidence interval) for BAP was 4.38 (1.45, 13.21) among 65 subjects with years since menopause (YSM) < 5 years. RRs per SD (95 % confidence interval) for BAP, tDPD, and fDPD were 1.39 (1.12, 1.74), 1.32 (1.05, 1.67), and 1.40 (1.12, 1.76), respectively, after adjusting for age and femoral neck bone mineral density (FN BMD) among 457 subjects with YSM ≥ 5 years. Of the 451 women followed at least once until 2002, RRs per SD for BAP, tDPD, and fDPD adjusted for age and FN BMD over 6 years were not significantly different from those over 10 years.

Conclusion

BAP was associated with vertebral fracture risk among early postmenopausal women. BTMs can predict vertebral fractures independently of BMD among late postmenopausal women over a 10-year follow-up period.

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Acknowledgments

This study was conducted by the JPOS Study Group, comprising Fumiaki Marumo (Chairman of the Study Group, Professor Emeritus, Tokyo Medical and Dental University), Toshihisa Matsuzaki (Co-chairman of the Study Group, Institute of Comprehensive Community Care), Tomoharu Matsukura (Kanazawa University), and Takashi Yamagami (Hokuriku Health Service Association), along with the authors. Financial support for the baseline survey was provided by the Japan Milk Promotion Board and the Japan Dairy Council. The follow-up surveys were supported by Grants-in-aid for Scientific Research (B #10470114, 1998–2000, B #14370147, 2002–2003, B #18390201, 2006–2008, and C #18590619, 2006–2009) from the Japanese Society for the Promotion of Science, a grant in 2000–2002 from the Research Society for Metabolic Bone Diseases, Japan, and a Grand-in-Aid to study Milk Nutrition (2006) from the Japan Dairy Association. The authors wish to express special thanks to the personnel of the health departments of Miyako-jima City, Sanuki City, and Nishi-Aizu Town for their excellent support of the study, and to those from SRL, Tokyo, Japan; Toyo Medic, Osaka, Japan; and Toyukai Medical Corporation, Tokyo, Japan, for their technical assistance with the surveys.

Conflicts of interest

None.

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Authors and Affiliations

  1. Department of Public Health, Faculty of Medicine, Kinki University, 377-2, Oono-higasi, Osaka-sayama, Osaka, 589-8511, Japan

    J. Tamaki, M. Iki & E. Kadowaki

  2. Department of Human Life, Jin-ai University, Echizen, Japan

    Y. Sato

  3. Division of Biostatistics, Clinical Research Center, Faculty of Medicine, Kinki University, Osaka, Japan

    Y. Chiba

  4. Department of Blood Purification and Internal Medicine, Kidney Center, Tokyo Women’s Medical University, Tokyo, Japan

    T. Akiba

  5. Department of Medicine and Bioregulatory Sciences, Graduate School of Health Biosciences, University of Tokushima, Tokushima, Japan

    T. Matsumoto

  6. Nippon Express Co., Inc., Toyama, Japan

    H. Nishino

  7. University of Toyama, Toyama, Japan

    S. Kagamimori

  8. Kagawa Nutrition University, Saitama, Japan

    Y. Kagawa

  9. Shuuwa General Hospital, Saitama, Japan

    H. Yoneshima

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  1. J. Tamaki
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Tamaki, J., Iki, M., Kadowaki, E. et al. Biochemical markers for bone turnover predict risk of vertebral fractures in postmenopausal women over 10 years: the Japanese Population-based Osteoporosis (JPOS) Cohort Study. Osteoporos Int 24, 887–897 (2013). https://doi.org/10.1007/s00198-012-2106-7

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