Biochemical markers of bone turnover may predict progression to osteoporosis in osteopenic women: the JPOS Cohort Study
Biochemical markers of bone turnover may predict progression to osteoporosis in osteopenic women: the JPOS Cohort Study
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DOI：
10.1007/s00774-006-0736-6
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发表时间：
2007-03-01
影响因子：
3.3
通讯作者：
Yoneshima, Hideo
中科院分区：
文献类型：
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作者：
Iki, Masayuki;Morita, Akemi;Yoneshima, Hideo
我们评估了血清骨钙素(OC)、骨特异性碱性磷酸酶、尿中I型胶原C端肽、游离和总脱氧吡啶酚(TDPD)等骨转换标志物的价值，以预测哪些骨量减少的妇女[即那些骨量减少的妇女[即青壮年平均骨密度(BMD)的70%和80%]将进展到BMD的骨质疏松水平(YAM的70%)。在完成3年随访的1153名无骨代谢缺陷的女性中，147名、161名和144名女性分别通过基线测量脊柱(LS)、髋部(TH)和桡骨远端(DR)的骨密度，被双X射线骨密度仪判定为骨量减少。在LS、TH和DR骨量减少的受试者中，分别有23.8%、16.1%和12.5%的受试者进展到骨质疏松症水平，而他们中的大多数人的骨密度水平处于基线水平的下半部。在这类骨质减少程度较低的受试者中，观察到在LS有骨质疏松进展的受试者的OC水平显著高于无骨质疏松进展的受试者。糖尿病视网膜病变进展的受试者tDPD水平显著升高。在调整了基线时的年龄、体型和骨密度后，OC水平和疾病进展之间的关联没有改变。在调整了基线时的年龄、体型和BMD后，OC水平上三分之一类别的受试者在LS(95%可信区间，1.8-23.1)方面的进展风险是低三分之一类别受试者的6.4倍。受试者操作特征分析显示，在预测LS的骨质疏松进展时，OC水平的曲线下面积为0.716。OC和tDPD水平可能有助于预测哪些骨量减少的女性会进展为骨质疏松症。
We evaluated the value of bone turnover markers, including osteocalcin (OC) and bone-specific alkaline phosphatase in the serum, and type I collagen C-terminal telopeptide and free and total deoxypyridinoline (tDPD) in the urine of fasting patients, in an attempt to predict which osteopenic women [i.e., those with >= 70% and < 80% of the young adult mean (YAM) bone mineral density (BMD)] would progress to the osteoporosis level of BMD (< 70% of YAM). Of the 1153 women without defects in bone metabolism who completed the 3-year follow-up, 147, 161, and 144 women were judged by dual X-ray absorptiometry to be osteopenic from baseline measurements of BMD in the spine (LS), hip (TH), and distal radius (DR), respectively. Progression to the osteoporotic level of BMD was noted for 23.8%, 16.1%, and 12.5% of the subjects with osteopenia of the LS, TH, and DR, respectively, while most of them were in the lower half of the osteopenic level of BMD at baseline. Among the subjects in this lower-level osteopenia category, a significantly higher OC level was observed for the subjects with osteoporosis progression at the LS than those without. The subjects with progression at DR showed a significantly higher tDPD level. The association between OC level and disease progression remained unchanged after adjustments for age, body size, and BMD at baseline. The subjects in the upper one-third category of OC levels showed a 6.4 fold greater risk of progression at LS (95% confidence interval, 1.8-23.1) compared with those in the lower one-third category after the adjustments for age, body size, and BMD at baseline. Receiver operating characteristics analysis showed that the area under the curve was 0.716 for the OC level in the prediction of osteoporosis progression at LS. The levels of OC and tDPD may be useful in predicting which osteopenic women will progress to osteoporosis.