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BACKGROUND: In the European Prospective Osteoporosis Study (EPOS), a past spine fracture increased risk of an incident fracture 3.6 - 12-fold even after adjusting for BMD. We examined the possibility that biochemical marker levels were associated with this unexplained BMD-independent element of fracture risk. METHODS: Each of 182 cases in EPOS of spine or non-spine fracture that occurred in 3.8 years of follow-up was matched by age, sex and study centre with two randomly assigned never-fractured controls and one case of past fracture. Analytes measured blind were: osteocalcin, bone-specific alkaline phosphatase, total alkaline phosphatase, serum creatinine, calcium, phosphate and albumin, together with the collagen cross-links degradation products serum CTS and urine CTX. Most subjects also had bone density measured by DXA. RESULTS: Cases who had recent fractures did not differ in marker levels from cases who had their last fracture more than 3 years previously. No statistically significant effect of recent fracture was found for any marker except osteocalcin, which was 17.6% lower in recent peripheral cases compared to unfractured controls (p<0.05) and this was independent of BMD. CONCLUSION: Past fracture as a risk indicator for future fracture is not strongly mediated through increased bone turnover.

Original publication

DOI

10.1016/s0009-8981(02)00164-x

Type

Journal article

Journal

Clinica chimica acta; international journal of clinical chemistry

Publication Date

08/2002

Volume

322

Pages

121 - 132

Addresses

U. INSERM 403, Lyon, France.

Keywords

Humans, Spinal Fractures, Recurrence, Phosphates, Calcium, Creatinine, Collagen, Alkaline Phosphatase, Vitamin D, Osteocalcin, Biological Markers, Prognosis, Matched-Pair Analysis, Follow-Up Studies, Bone Remodeling, Aging, Sex Characteristics, Bone Density, Aged, Middle Aged, Female, Male, Fractures, Bone