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Journal of Clinical Endocrinology & Metabolism , doi:10.1210/jc.2006-2695
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The Journal of Clinical Endocrinology & Metabolism Vol. 92, No. 9 3453-3457
Copyright © 2007 by The Endocrine Society

Racial and Ethnic Differences in Bone Turnover Markers in Men

Benjamin Z. Leder, Andre B. Araujo, Thomas G. Travison and John B. McKinlay

Endocrine Unit (B.Z.L.), Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts 02114; and New England Research Institutes (A.B.A., T.G.T., J.B.M.), Watertown, Massachusetts 02472

Address all correspondence and requests for reprints to: Benjamin Z. Leder, M.D., Endocrine Unit, Massachusetts General Hospital, Thier 1047, 50 Blossom Street, Boston, Massachusetts 02114. E-mail: bzleder{at}partners.org.


   Abstract
Top
 Abstract
Introduction
 Subjects and Methods
 Results
 Discussion
 References
 
Context: Whereas racial and ethnic differences in fracture risk and bone mineral density (BMD) in men have been well described, the influence of race and ethnicity on biochemical markers of bone turnover is less clear.

Methods: To examine the relationship between bone turnover, BMD, and race and ethnicity in men, we measured BMD, serum intact osteocalcin (OC), and serum C-terminal telopeptides of type 1 collagen (CTx) in 1029 men (aged 30–79 yr) enrolled in the Boston Area Community Health/Bone Survey, a population-based random sample of Black, Hispanic, and White. Men with diseases or on medications known to affect bone metabolism were excluded from the analysis. Mean serum levels of OC and CTx were adjusted for age, month and time of blood sample, and 25-hydroxyvitamin D.

Results: Compared with Black men, adjusted mean OC levels were 17.6 and 20.5% higher in Hispanic (P = 0.02) and White men (P < 0.01), respectively. There was no significant difference between White and Hispanic men. Adjusted mean CTx levels were 14.3% higher in White men, compared with Black men (P = 0.04), but no other differences were significant. OC declined by 0.4%/yr from age 30 to 65 yr and increased thereafter by 2.1%/yr. The age trend in CTx appeared to follow a pattern consistent with a quadratic function of age. Model-estimated annual percent changes within age decade were as follows: 30–39 yr, –2.5%; 40–49 yr, –1.4%; 50–59 yr, –0.3%; 60–69 yr, +0.9%; 70–79 yr, +1.7%. There was no variation in the shape of the age trend in OC or CTx by race or ethnic group. Correlations between bone turnover markers and BMD (adjusted for age, height, weight, serum 25-hydroxyvitamin D, and PTH and month and time of blood sample) were generally weak.

Conclusions: Bone turnover markers are lower in Black men, compared with White and Hispanic men. Age trends in bone turnover markers are not influenced by race or ethnicity. Future studies in this cohort and others are needed to explore further these reported differences in bone metabolism among Black, Hispanic, and White men.


   Introduction
Top
 Abstract
 Introduction
Subjects and Methods
 Results
 Discussion
 References
 
OSTEOPOROSIS IN MEN is increasingly recognized as a major public health issue, contributing significantly to morbidity and mortality in our aging population (1, 2). Numerous risk factors for osteoporotic fracture have been identified in men, many of which are common to those identified in women (3, 4, 5). Among these, race and ethnicity are known to be associated with fracture, with higher rates in White men and lower rates among Black, Hispanic, and Asian men (6, 7, 8, 9, 10, 11, 12, 13, 14). Bone mineral density (BMD), which is closely associated with hip, vertebral, and overall fracture rates in men (15), also differs by race and ethnicity (16, 17, 18, 19, 20, 21, 22, 23, 24). Yet while BMD is known to be a powerful predictor of fracture risk in men, differences in BMD alone cannot account for the diverse rates of fractures in varied populations (25, 26).

Recently, biochemical markers of bone turnover have become increasingly useful in assessing changes in the metabolic activity of the skeleton, measuring response to osteoporosis therapy, and helping to explain the mechanisms of action of various hormonal and therapeutic mediators of skeletal integrity (27). Furthermore, high bone turnover appears to be an independent risk factor for fracture in men (28). The relationship between race and ethnicity and bone turnover in men, however, has not been comprehensively examined. In the present study, we sought to characterize the influence of race and ethnicity on biochemical markers of bone turnover as well as the effect of race and ethnicity on age-related changes in bone turnover. To achieve this goal, we measured BMD, serum intact osteocalcin (OC), and serum C-terminal telopeptides of type 1 collagen (CTx) in a diverse population of men enrolled in the Boston Area Community Health/Bone (BACH/Bone) Survey.


   Subjects and Methods
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 Abstract
 Introduction
 Subjects and Methods
Results
 Discussion
 References
 
Study sample

BACH/Bone is a cross-sectional observational study of 1219 (of 1877 eligible, 65% response rate) randomly selected Black, Hispanic, and White male residents of Boston, Massachusetts, aged 30–79 yr (16). Persons of other racial or ethnic backgrounds were not enrolled. The BACH/Bone study was powered according to its primary aim of detecting race and ethnic differences in BMD. A priori power calculations indicated that a sample size of 300 subjects per race and ethnic subsample would yield greater than 80% power to detect a difference of 0.039 g/cm2 in mean BMD between any two racial and ethnic subpopulations. Enrollment for the study exceeded this minimum goal (367 Black, 401 Hispanic, 451 White subjects enrolled). This protocol was approved by institutional review boards at New England Research Institutes and Boston University School of Medicine (BUSM). All participants gave written informed consent.

Data collection

Data collection was performed by trained staff in a research clinic at BUSM. Race and ethnicity were determined according to the federal standard (29), with respondents self-identifying themselves as Black, Hispanic, or White via two questions on Hispanic ethnicity and racial status.

Bone turnover marker measurements

Serum measurements were performed at The Core Laboratory, BUSM. Blood samples were nonfasting, and collection times ranged from 0745 to 2000 h. Serum intact OC, a marker of bone formation, was measured in duplicate with the Nichols Advantage System (Nichols Institute Diagnostics, San Clemente, CA). Serum CTx, a marker of bone resorption, was measured with Serum CrossLaps ELISA (Nordic Bioscience Diagnostics, Herlev, Denmark). Intraassay coefficients of variation for OC and CTx are 5.3 and 5.0%, respectively. Interassay coefficients of variation for OC and CTx are less than 10 and 8.1%, respectively. Serum 25-hydroxyvitamin D [25(OH)D] was measured by a competitive binding protein assay (30) and serum biointact PTH with the Nichols Advantage System (Nichols Institute Diagnostics).

BMD measurements

BMD (grams per square centimeter) at the hip, anteroposterior lumbar spine (L1-L4), and forearm was measured by dual-energy x-ray absorptiometry using a QDR 4500 W densitometer (Hologic, Inc., Waltham, MA) located at the BUSM. The scanner was calibrated daily with an anthropometric (vertebral) phantom.

Statistical analysis

Visual displays showed substantial skew in OC and CTx. We transformed OC (square root) and CTx (log) to enhance their compliance with the assumptions of regression models (e.g. to enhance linearity and equality of variance in outcomes over the age range and to reduce skew). We judged the adequacy of the transformations by visual inspection. Transformed values were used in all analyses, with values back-transformed to their original units for presentation. We examined race and ethnic differences in descriptive characteristics by means of ANOVA, with Wald tests used for hypothesis testing. Based on previous work (31), it was anticipated that turnover markers may have nonlinear trends in age. Visual displays (with locally weighted linear regression) (32) and exploratory analyses supported this. We relied on Wald tests to judge the significance of terms in making modeling decisions. We also tested for race and ethnic differences in the shape of age trends in OC and CTx. These statistical models contained an age spline (OC) or age2 (CTx) term, and comparisons were made by assessing interaction through the use of race/ethnicity (represented by two indicator variables) and their product with both the age and age spline (OC) or age2 (CTx) terms. The significance of these effects was assessed via an F-statistic on four degrees of freedom. Percentage age changes, within appropriate age segments, in OC and CTx were obtained by dividing the model-estimated per-year change in (square root) OC and (log) CTx by the adjusted mean (square root) OC and (log) CTx for a typical 50-yr-old subject. Partial correlation coefficients (rp) were used to estimate the association between bone turnover markers and BMD adjusting for covariates [age, height, weight, serum 25(OH)D, and PTH and month and time of blood sample].

Analysis sample

Of the 1219 men, 1138 had serum available for analysis. The following exclusions were made: missing OC or CTx (n = 4); missing BMD (n = 10); exclusionary medication use (current), which included all anticoagulants, testosterone, glucocorticoids, selected anticonvulsants (phenytoin, carbamazepine, and Depakote, Phenobarbital), suppressive doses of T4 in men with thyroid cancer, and lithium (n = 65); self-reported osteoporosis (n = 11); serum calcium greater than 10.1 mg/dl and serum PTH greater than 50 pg/ml (n = 5); and outlying data values (>4 SD from mean) (n = 14). This left 1029 men for analysis, none of whom reported a fracture in the past 6 months (also an exclusion).


   Results
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 Abstract
 Introduction
 Subjects and Methods
 Results
Discussion
 References
 
Of the 1029 men in the analysis sample, 307 (29.8%) were Black, 332 (32.3%) were Hispanic, and 390 (37.9%) were White. There were race and ethnic group differences on all variables considered with the exception of BMI and PTH (Table 1Go). Race and ethnic group-specific medians and 2.5 and 97.5 percentiles for OC and CTx are displayed in Table 1Go. Median OC was clearly higher in White as compared with Black and Hispanic subjects, and the upper limit of normal, defined as the 97.5 percentile, was higher in Hispanic and White subjects, compared with Black subjects. There were no appreciable differences in CTx medians or percentiles among the groups.


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  		TABLE 1. Descriptive characteristics of the sample by race and ethnic group (n = 1029)

 
Mean serum OC and CTx adjusted for age, month and time of blood sample, and 25(OH)D level is shown in Fig. 1Go, A and B, respectively. Compared with Black men, adjusted mean OC was 17.6 and 20.5% higher in Hispanic (P = 0.02) and White men (P < 0.01), respectively. There was no significant difference between White and Hispanic men. Adjusted mean CTx was 14.3% higher in White compared with Black men (P = 0.04), and whereas mean CTx was 11.1% higher in White compared with Hispanic men (P = 0.08). Note that adjustment for 25(OH)D level was made due to the large differences in vitamin D levels between racial and ethnic groups. When serum 25(OH)D levels are removed from the model, the Black/Hispanic and Black/White differences in OC are slightly reduced (16.2 and 18.5%, respectively), and the Black/White difference in CTx is no longer significant (P = 0.16). Figure 1Go, C and D, shows age trends in OC and CTx. The age trend in OC appeared to follow a pattern that was consistent with a two-slope linear model with a single knot at age 65 yr. OC declined by approximately 0.4%/yr between the ages of 30 and 65 yr and increased by approximately 2.1%/yr after age 65 yr. The age trend in CTx appeared to follow a pattern consistent with a quadratic function of age. Model-estimated yearly percent changes within age decade were as follows: 30–39 yr, – 2.5%; 40–49 yr, – 1.4%; 50–59 yr, – 0.3%; 60–69 yr, +0.9%; and 70–79 yr, +1.7%. We found no evidence of variation in the shape of the age trend in OC (P = 0.29) or CTx (P = 0.76) by race and ethnic group.


Figure 1
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  		FIG. 1. A and B, Mean (95% confidence interval) OC (A) and CTx (B) by race and ethnic group, adjusted for age, serum 25(OH)D, and month and time of blood sample. Adjusted means were obtained from linear regression models using square root OC and log CTx as outcomes, which were then back-transformed to their original units for presentation. C and D, Age trends in OC (C) and CTx (D). Fitted lines are generated using locally weighted linear regression (smoothing parameter = 0.5), n = 1029, BACH/Bone 2002–2005.

 
We examined partial correlations (rp), adjusted for age, height, weight, 25(OH)D, PTH, and month and time of blood sample, between bone turnover markers and BMD. There were weak but significant negative correlations between serum OC and BMD at the proximal femur (femoral neck rp = –0.10; total hip rp = –0.12) as well as between CTx and total hip (rp = –0.08) and ultradistal radius (rp = –0.09) BMD.


   Discussion
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 Abstract
 Introduction
 Subjects and Methods
 Results
 Discussion
References
 
In this study we report that adjusted serum OC is lower in Black men, compared with White and Hispanic men. CTx is also lower in Black men compared with White men, but not different from Hispanic men. In previous studies performed in women, most, but not all, have similarly reported that bone formation markers are lower in Black compared with White subjects (9, 33, 34, 35, 36) whereas differences in markers of bone resorption were inconsistently found (9, 33, 34, 35, 36, 37, 38). In men, the Third National Health and Nutrition Examination Survey study reported lower serum OC among Black subjects but reported no between-group differences in another biochemical marker of bone formation, bone-specific alkaline phosphatase (31). Data on racial differences in bone resorption are less robust, although the present study generally confirms the results of previous small studies (9, 39).

The mechanisms underlying the lower serum levels of OC and CTx in Black men are unclear. It has been suggested that these differences could be due to racial differences in the skeletal sensitivity to PTH. That hypothesis is supported by a study in women that demonstrated a greater increase in bone resorption markers in White vs. Black women undergoing PTH infusion (40). The PTH-induced response in bone formation markers in this study, however, showed no racial differences, making this mechanistic explanation less pertinent to our finding of decreased bone formation in Black men. Alternatively, because 1,25-dihydroxyvitamin D directly stimulates OC gene transcription and synthesis (41), the lower serum 25(OH)D in Black men could be contributing to the observed lower serum OC. Similarly, because 1,25-dihydroxyvitamin D directly stimulates osteoblast/stromal cell expression of receptor activator of nuclear factor-{kappa}B ligand, down-regulates osteoblast/stromal cell expression of osteoprotegerin, and stimulates osteoclastic receptor activator of nuclear factor-{kappa}B expression (42), the lower 25(OH)D in Black men may also help explain differences in CTx. These latter hypotheses are consistent with our findings that removing serum 25(OH)D from the linear regression narrowed between group differences in OC and CTx (42). Clearly, however, the influence of serum 25(OH)D is modest, pointing to more complex mechanisms including potential racial/ethnic differences in vitamin D receptor polymorphisms or other genetic factors (43, 44, 45, 46).

In this study we also describe the age-related changes in OC and CTx in men. The increase in OC we observed in the later decades was also reported in the National Health and Nutrition Examination Survey cohort and in some, but not all, smaller studies (31, 47, 48). The observed age-related changes in CTx we report also generally agree with previous reports of smaller numbers of patients (48, 49). We then further attempted to explore the relationship between bone turnover and BMD in Black, Hispanic, and White men. Whereas associations between bone turnover and BMD were found, they were inconsistent, relatively weak, and not influenced by race and ethnicity. Taken together, these results suggest that neither differences in overall bone turnover nor differences in the effect of age on bone turnover are likely to explain the observed differences in BMD between racial/ethnic groups.

The interpretation of our study is limited by the fact that a single measurement of a single bone resorption and formation marker may not consistently represent that subject’s steady-state level of bone turnover. Additionally, the fact that the markers were not consistently measured in the fasting state likely added to their variability (particularly CTx). Nonetheless, the strengths of this study, including the large racially diverse population-based cohort, provide important information regarding the influence of race and ethnicity on bone turnover in men. The conclusion we have drawn, namely that bone turnover markers are generally lower in Black men compared with other ethnic groups, and that the relationship between bone turnover and bone density is generally weak and not influenced by race and ethnicity should help inform ongoing research in this area.


   Footnotes
 
The BACH/Bone Survey was supported by Grant AG 20727 from the National Institute on Aging. The parent study (BACH) was supported by Grant DK 56842 from the National Institute of Diabetes and Digestive and Kidney Diseases. B.Z.L. was supported by National Institutes of Health Grant K23-RR16310.

None of the authors has a conflict of interest.

First Published Online June 19, 2007

Abbreviations: BACH/Bone, Boston Area Community Health/Bone Survey; BMD, bone mineral density; BUSM, Boston University School of Medicine; CTx, C-terminal telopeptides of type 1 collagen; OC, osteocalcin; 25(OH)D, 25-hydroxyvitamin D; rp, partial correlation coefficient.

Received December 6, 2006.

Accepted June 8, 2007.


   References
Top
 Abstract
 Introduction
 Subjects and Methods
 Results
 Discussion
 References
 

  1. Bilezikian JP 1999 Osteoporosis in men. J Clin Endocrinol Metab 84:3431–3434[Free Full Text]
  2. Orwoll ES 1998 Osteoporosis in men. Endocrinol Metab Clin North Am 27:349–367[CrossRef][Medline]
  3. Seeman E, Melton LJ, O’Fallon WM, Riggs BL 1983 Risk factors for spinal osteoporosis in men. Am J Med 75:977–983[CrossRef][Medline]
  4. Anderson FH, Cooper C 1999 Hip and vertebral fractures. In: Orwoll ES, ed. Osteoporosis in men. San Diego: Academic Press; 29–49
  5. Nguyen TV, Eisman JA, Kelly PJ, Sambrook PN 1996 Risk factors for osteoporotic fractures in elderly men. Am J Epidemiol 144:255–263[Abstract/Free Full Text]
  6. Anderson JJ, Pollitzer WS 1994 Ethnic and genetic differences in susceptibility to osteoporotic fractures. Adv Nutr Res 9:129–149[Medline]
  7. Barrett JA, Baron JA, Karagas MR, Beach ML 1999 Fracture risk in the U.S. Medicare population. J Clin Epidemiol 52:243–249[CrossRef][Medline]
  8. Bauer RL 1988 Ethnic differences in hip fracture: a reduced incidence in Mexican Americans. Am J Epidemiol 127:145–149[Abstract/Free Full Text]
  9. Henry YM, Eastell R 2000 Ethnic and gender differences in bone mineral density and bone turnover in young adults: effect of bone size. Osteoporos Int 11:512–517[CrossRef][Medline]
  10. Jacobsen SJ, Goldberg J, Miles TP, Brody JA, Stiers W, Rimm AA 1990 Hip fracture incidence among the old and very old: a population-based study of 745,435 cases. Am J Public Health 80:871–873[Abstract/Free Full Text]
  11. Karagas MR, Lu-Yao GL, Barrett JA, Beach ML, Baron JA 1996 Heterogeneity of hip fracture: age, race, sex, and geographic patterns of femoral neck and trochanteric fractures among the U.S. elderly. Am J Epidemiol 143:677–682[Abstract/Free Full Text]
  12. Lauderdale DS, Jacobsen SJ, Furner SE, Levy PS, Brody JA, Goldberg J 1997 Hip fracture incidence among elderly Asian-American populations. Am J Epidemiol 146:502–509[Abstract/Free Full Text]
  13. Lauderdale DS, Jacobsen SJ, Furner SE, Levy PS, Brody JA, Goldberg J 1998 Hip fracture incidence among elderly Hispanics. Am J Public Health 88:1245–1247[Abstract/Free Full Text]
  14. Silverman SL, Madison RE 1988 Decreased incidence of hip fracture in Hispanics, Asians, and Blacks: California Hospital Discharge Data. Am J Public Health 78:1482–1483[Abstract/Free Full Text]
  15. Ross PD, Lombardi A, Freedholm D 1999 The assessment of bone mass in men. In: Orwoll E, ed. Osteoporosis in men. San Diego: Academic Press; 505–525
  16. Araujo AB, Travison TG, Harris SS, Holick MF, Turner AK, McKinlay JB 2007 Race/ethnic differences in bone mineral density in men. Osteoporos Int 18:943–953[CrossRef][Medline]
  17. Barondess DA, Nelson DA, Schlaen SE 1997 Whole body bone, fat, and lean mass in black and white men. J Bone Miner Res 12:967–971[CrossRef][Medline]
  18. Cauley JA, Fullman RL, Stone KL, Zmuda JM, Bauer DC, Barrett-Connor E, Ensrud K, Lau EM, Orwoll ES 2005 Factors associated with the lumbar spine and proximal femur bone mineral density in older men. Osteoporos Int 16:1525–1537[CrossRef][Medline]
  19. George A, Tracy JK, Meyer WA, Flores RH, Wilson PD, Hochberg MC 2003 Racial differences in bone mineral density in older men. J Bone Miner Res 18:2238–2244[CrossRef][Medline]
  20. Looker AC, Orwoll ES, Johnston Jr CC, Lindsay RL, Wahner HW, Dunn WL, Calvo MS, Harris TB, Heyse SP 1997 Prevalence of low femoral bone density in older U.S. adults from NHANES III. J Bone Miner Res 12:1761–1768[CrossRef][Medline]
  21. Looker AC, Wahner HW, Dunn WL, Calvo MS, Harris TB, Heyse SP, Johnston Jr CC, Lindsay R 1998 Updated data on proximal femur bone mineral levels of U.S. adults. Osteoporos Int 8:468–489[CrossRef][Medline]
  22. Melton IL, Marquez MA, Achenbach SJ, Tefferi A, O’Connor MK, O’Fallon WM, Riggs BL 2002 Variations in bone density among persons of African heritage. Osteoporos Int 13:551–559[CrossRef][Medline]
  23. Nelson DA, Jacobsen G, Barondess DA, Parfitt AM 1995 Ethnic differences in regional bone density, hip axis length, and lifestyle variables among healthy black and white men. J Bone Miner Res 10:782–787[Medline]
  24. Ruffing J, Cosman F, Zion M, Tendy S, Garrett P, Lindsay R, Nieves J 2006 Determinants of bone mass and bone size in a large cohort of physically active young adult men. Nutr Metab (Lond) 3:14
  25. Recker RR, Barger-Lux MJ 2004 The elusive concept of bone quality. Curr Osteoporos Rep 2:97–100[Medline]
  26. Nelson DA, Megyesi MS 2004 Sex and ethnic differences in bone architecture. Curr Osteoporos Rep 2:65–69[CrossRef][Medline]
  27. Looker AC, Bauer DC, Chesnut 3rd CH, Gundberg CM, Hochberg MC, Klee G, Kleerekoper M, Watts NB, Bell NH 2000 Clinical use of biochemical markers of bone remodeling: current status and future directions. Osteoporos Int 11:467–480[CrossRef][Medline]
  28. Meier C, Nguyen TV, Center JR, Seibel MJ, Eisman JA 2005 Bone resorption and osteoporotic fractures in elderly men: the dubbo osteoporosis epidemiology study. J Bone Miner Res 20:579–587[CrossRef][Medline]
  29. Wallman K 1997 Data on race and ethnicity: revising the federal standard. Am Stat 31–35
  30. Chen TC, Turner AK, Holick MF 1990 Methods for the determination of the circulating concentration of 25-hydroxyvitamin D. J Nutr Biochem 1:315–319[CrossRef][Medline]
  31. Gundberg CM, Looker AC, Nieman SD, Calvo MS 2002 Patterns of osteocalcin and bone specific alkaline phosphatase by age, gender, and race or ethnicity. Bone 31:703–708[Medline]
  32. Hastie TJ, Tibshirani RJ 1990 Generalized additive models. Boca Raton, FL: Chapman and Hall/CRC
  33. Ettinger B, Sidney S, Cummings SR, Libanati C, Bikle DD, Tekawa IS, Tolan K, Steiger P 1997 Racial differences in bone density between young adult black and white subjects persist after adjustment for anthropometric, lifestyle, and biochemical differences. J Clin Endocrinol Metab 82:429–434[Abstract/Free Full Text]
  34. Kleerekoper M, Nelson DA, Peterson EL, Flynn MJ, Pawluszka AS, Jacobsen G, Wilson P 1994 Reference data for bone mass, calciotropic hormones, and biochemical markers of bone remodeling in older (55–75) postmenopausal white and black women. J Bone Miner Res 9:1267–1276[Medline]
  35. Meier DE, Luckey MM, Wallenstein S, Lapinski RH, Catherwood B 1992 Racial differences in pre- and postmenopausal bone homeostasis: association with bone density. J Bone Miner Res 7:1181–1189[Medline]
  36. Finkelstein JS, Sowers M, Greendale GA, Lee ML, Neer RM, Cauley JA, Ettinger B 2002 Ethnic variation in bone turnover in pre- and early perimenopausal women: effects of anthropometric and lifestyle factors. J Clin Endocrinol Metab 87:3051–3056[Abstract/Free Full Text]
  37. Bell NH, Williamson BT, Hollis BW, Riggs BL 2001 Effects of race on diurnal patterns of renal conservation of calcium and bone resorption in premenopausal women. Osteoporos Int 12:43–48[CrossRef][Medline]
  38. Harris SS, Soteriades E, Dawson-Hughes B 2001 Secondary hyperparathyroidism and bone turnover in elderly blacks and whites. J Clin Endocrinol Metab 86:3801–3804[Abstract/Free Full Text]
  39. Dibba B, Prentice A, Laskey MA, Stirling DM, Cole TJ 1999 An investigation of ethnic differences in bone mineral, hip axis length, calcium metabolism and bone turnover between West African and Caucasian adults living in the United Kingdom. Ann Hum Biol 26:229–242[CrossRef][Medline]
  40. Cosman F, Morgan DC, Nieves JW, Shen V, Luckey MM, Dempster DW, Lindsay R, Parisien M 1997 Resistance to bone resorbing effects of PTH in black women. J Bone Miner Res 12:958–966[CrossRef][Medline]
  41. Beresford JN, Gallagher JA, Poser JW, Russell RG 1984 Production of osteocalcin by human bone cells in vitro. Effects of 1,25(OH)2D3, 24,25(OH)2D3, parathyroid hormone, and glucocorticoids. Metab Bone Dis Relat Res 5:229–234[CrossRef][Medline]
  42. Boyle WJ, Simonet WS, Lacey DL 2003 Osteoclast differentiation and activation. Nature 423:337–342[CrossRef][Medline]
  43. Dvornyk V, Liu XH, Shen H, Lei SF, Zhao LJ, Huang QR, Qin YJ, Jiang DK, Long JR, Zhang YY, Gong G, Recker RR, Deng HW 2003 Differentiation of Caucasians and Chinese at bone mass candidate genes: implication for ethnic difference of bone mass. Ann Hum Genet 67(Pt 3):216–227
  44. Fang Y, van Meurs JB, Bergink AP, Hofman A, van Duijn CM, van Leeuwen JP, Pols HA, Uitterlinden AG 2003 Cdx-2 polymorphism in the promoter region of the human vitamin D receptor gene determines susceptibility to fracture in the elderly. J Bone Miner Res 18:1632–1641[CrossRef][Medline]
  45. Nelson DA, Vande Vord PJ, Wooley PH 2000 Polymorphism in the vitamin D receptor gene and bone mass in African-American and white mothers and children: a preliminary report. Ann Rheum Dis 59:626–630[Abstract/Free Full Text]
  46. Lau HH, Ng MY, Cheung WM, Paterson AD, Sham PC, Luk KD, Chan V, Kung AW 2006 Assessment of linkage and association of 13 genetic loci with bone mineral density. J Bone Miner Metab 24:226–234[CrossRef][Medline]
  47. Wishart JM, Need AG, Horowitz M, Morris HA, Nordin BE 1995 Effect of age on bone density and bone turnover in men. Clin Endocrinol (Oxf) 42:141–146[Medline]
  48. Fatayerji D, Eastell R 1999 Age-related changes in bone turnover in men. J Bone Miner Res 14:1203–1210[CrossRef][Medline]
  49. Orwoll ES, Bell NH, Nanes MS, Flessland KA, Pettinger MB, Mallinak NJ, Cain DF 1998 Collagen N-telopeptide excretion in men: the effects of age and intrasubject variability. J Clin Endocrinol Metab 83:3930–3935[Abstract/Free Full Text]



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