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Serial Assessment of Serum Bone Metabolism Markers Identifies Women with the Highest Rate of Bone Loss and Osteoporosis Risk

Clinical and Molecular Osteoporosis Research Unit (K.K.I., J.L., P.G., K.Å, K.J.O.), Lund University, Department of Orthopaedics, Malmö University Hospital, SE-20502 Malmö, Sweden; University of Turku (K.K.I., H.K.V.), Institute of Biomedicine, Department of Anatomy, FI-20520 Turku, Finland; and Karolinska Institute (P.G.), Department of Orthopaedics, Karolinska University Hospital, SE-14186 Stockholm, Sweden

Address all correspondence and requests for reprints to: Kaisa Ivaska, Clinical and Molecular Osteoporosis Research Unit, Department of Orthopaedics, Malmö University Hospital, SE-20502 Malmö, Sweden. E-mail: kaisa.ivaska{at}med.lu.se.

Context: One of the important challenges in the management of osteoporosis is to identify women who are at high risk of developing osteoporosis and fragility fractures.

Objective: Our objective was to evaluate whether assessment of bone metabolism at multiple occasions can identify women with the highest risk for bone loss.

Design: The Malmö Osteoporosis Prospective Risk Assessment study is an ongoing longitudinal study. Participants have been evaluated at baseline and after 1, 3, and 5 yr.

Setting: We conducted a population-based study.

Participants: Participants included 1044 women, all 75 yr old at baseline.

Main Outcome Measures: Seven bone turnover markers were assessed at baseline and at 1, 3, and 5 yr (n = 573). The 5-yr change in areal bone mineral density (aBMD) was also determined.

Results: Baseline markers correlated weakly to change in total body aBMD. The associations were more pronounced when the average of the baseline and 1-yr measurements was used (standardized regression coefficients –0.12 to –0.23, P < 0.01). Adding the 3-yr and 5-yr measurement further strengthened the correlation (regression coefficients up to –0.30, P < 0.001). Women with constantly high turnover lost significantly more bone at total body assessment (–2.6%) than women with intermediate (–1.6%) or low turnover (–0.2%, P for trend < 0.001). They also had a greater decrease in hip BMD (–8.3, –6.0, and –5.1%, respectively, P = 0.010). Results were similar also in the subgroup of women with osteopenia.

Conclusions: Our results suggest that serial assessment of bone turnover improves the identification of women with the highest rate of bone loss and osteoporosis risk.

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