Original Research

Calcified Tissue International

, Volume 94, Issue 5, pp 560-567

A Meta-Analysis of Reference Markers of Bone Turnover for Prediction of Fracture

  • Helena JohanssonAffiliated withWHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School Email author 
  • , Anders OdénAffiliated withWHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School
  • , John A. KanisAffiliated withWHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School
  • , Eugene V. McCloskeyAffiliated withWHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School
  • , Howard A. MorrisAffiliated withSchool of Pharmacy and Medical Sciences, University of South Australia
  • , Cyrus CooperAffiliated withThe MRC Epidemiology Resource Centre, Southampton General Hospital, University of SouthamptonNIHR Musculoskeletal Biomedical Research Unit, Institute of Musculoskeletal Sciences, University of Oxford
  • , Samuel VasikaranAffiliated withDepartment of Core Clinical Pathology and Biochemistry, PathWest Laboratory Medicine, Royal Perth HospitalSchool of Pathology and Laboratory Medicine, University of Western Australia
  • , IFCC-IOF Joint Working Group on Standardisation of Biochemical Markers of Bone Turnover

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Abstract

The aim of this report was to summarize the clinical performance of two reference bone turnover markers (BTMs) in the prediction of fracture risk. We used an updated systematic review to examine the performance characteristics 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. We excluded cross-sectional studies. Ten potentially eligible publications were identified and six included in the meta-analysis. There was a significant association between s-PINP and the risk of fracture. The hazard ratio per SD increase in s-PINP (gradient of risk [GR]) was 1.23 (95 % CI 1.09–1.39) for men and women combined unadjusted for bone mineral density. There was also a significant association between s-CTX and risk of fracture, GR = 1.18 (95 % CI 1.05–1.34) unadjusted for bone mineral 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). Thus, there is a modest but significant association between BTMs and risk of future fractures.

Keywords

Marker of bone turnover Fracture Serum procollagen type I N propeptide Serum carboxy-terminal cross-linking telopeptide of type I collagen Meta-analysis