Markers of bone resorption predict hip fracture in elderly women: The EPIDOS prospective study
Markers of bone resorption predict hip fracture in elderly women: The EPIDOS prospective study
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DOI：
10.1002/jbmr.5650111021
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发表时间：
1996-10
影响因子：
6.2
通讯作者：
P. Garnero;E. Hausherr;M. Chapuy;C. Marcelli;H. Grandjean;C. Muller;C. Cormier;G. Bréart;P. Meunier;P. Delmas
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文献类型：
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作者：
P. Garnero;E. Hausherr;M. Chapuy;C. Marcelli;H. Grandjean;C. Muller;C. Cormier;G. Bréart;P. Meunier;P. Delmas
骨转换增加被认为是骨质疏松性骨折的潜在危险因素。我们在一项针对 7598 名 75 岁以上健康女性的前瞻性队列研究中调查了这一假设。在平均 22 个月的随访期间，有 126 名发生髋部骨折的女性（平均年龄 82.5 岁）与 3 名没有骨折的对照组进行了年龄匹配。在骨折前收集基线样本，用于测量两种骨形成标志物和三种骨吸收尿标志物：I 型胶原交联 N-（NTX）或 C-端肽（CTX）和游离脱氧吡啶啉（游离 D-Pyr）。与健康的绝经前女性相比，老年女性的骨形成和吸收有所增加。髋部骨折患者尿中 CTX 和游离 D-Pyr 的排泄量高于年龄匹配的对照组（p 分别为 0.02 和 0.005），但其他标志物则没有。 CTX 和游离 D-Pyr 排泄量高于绝经前范围上限与髋部骨折风险增加相关，比值比（95% 置信区间）分别为 2.2 (1.3-3.6) 和 1.9 (1.1-3.2)，而形成标志物则不然。骨吸收增加预测髋部骨折与骨量无关，即在调整股骨颈骨矿物质密度（BMD）之后并且与步态速度评估的活动状态无关。与仅具有低 BMD 或高骨吸收的女性相比，股骨 BMD 值低于年轻人平均值 2.5 SD 或更多且 CTX 或游离 D-Pyr 水平较高的女性发生髋部骨折的风险更大，比值比分别为 4.8 和 4.1。老年女性的特点是骨转换增加，一些骨吸收标志物可以预测随后发生髋部骨折的风险，与髋部 BMD 无关。结合骨密度和骨吸收的测量可能有助于改善老年女性髋部骨折风险的评估。
Increased bone turnover has been suggested as a potential risk factor for osteoporotic fractures. We investigated this hypothesis in a prospective cohort study performed on 7598 healthy women more than 75 years of age. One hundred and twenty‐six women (mean years 82.5) who sustained a hip fracture during a mean 22‐month follow‐up were age‐matched with three controls who did not fracture. Baseline samples were collected prior to fracture for the measurement of two markers of bone formation and three urinary markers of bone resorption: type I collagen cross‐linked N‐ (NTX) or C‐telopeptide (CTX) and free deoxypyridinoline (free D‐Pyr). Elderly women had increased bone formation and resorption compared with healthy premenopausal women. Urinary excretion of CTX and free D‐Pyr, but not other markers, was higher in patients with hip fracture than in age‐matched controls (p = 0.02 and 0.005, respectively). CTX and free D‐Pyr excretion above the upper limit of the premenopausal range was associated with an increased hip fracture risk with an odds ratio (95% confidence interval) of 2.2 (1.3‐3.6) and 1.9 (1.1‐3.2), respectively, while markers of formation were not. Increased bone resorption predicted hip fracture independently of bone mass, i.e., after adjustment for femoral neck bone mineral density (BMD) and independently of mobility status assessed by the gait speed. Women with both a femoral BMD value of 2.5 SD or more below the mean of young adults and either high CTX or high free D‐Pyr levels were at greater risk of hip fracture, with an odds ratio of 4.8 and 4.1, respectively, than those with only low BMD or high bone resorption. Elderly women are characterized by increased bone turnover, and some markers of bone resorption predict the subsequent risk of hip fracture independently of hip BMD. Combining the measurement of BMD and bone resorption may be useful to improve the assessment of the risk of hip fracture in elderly women.