Abstract
Objective: This study aimed to compare between periostin and osteocalcin as biomarkers in Egyptian postmenopausal women with osteoporosis and to explore their possible relationship with fracture risk.
 Methods: This study included 90 postmenopausal females recruited from Al-Hussein University Hospital, Cairo, Egypt; divided into three groups; 35 postmenopausal osteoporotic females with low fracture risk (group I), 35 postmenopausal osteoporotic females with high fracture risk (group II), and 20 apparently healthy controls. Serum periostin, osteocalcin, and estrogen were measured by Enzyme Linked Immunosorbent Assay (ELISA). Fracture risk assessment was calculated. Alkaline phosphatase (ALP), total and ionized calcium, Aspartate transaminase (AST), and Alanine transaminase (ALT) were measured spectrophotometrically.
 Results: The diagnostic performance of periostin for discriminating high fracture risk from low fracture risk groups showed the specificity of (68.6 %) and sensitivity of (100 %), while for osteocalcin the specificity was (51.4 %) and the sensitivity was (68.6 %) respectively. Moreover, the multi Receiver Operating Characteristics (multi-ROC) curve for periostin and osteocalcin together revealed improved specificity and sensitivity of (100 %) each.
 Conclusion: Periostin was superior to osteocalcin in discriminating high fracture risk from low fracture risk postmenopausal osteoporotic groups. Moreover, dual use of both markers gave the highest discriminative power between low and high fracture risk groups with 100 % specificity and sensitivity.
Highlights
Osteoporosis is a skeletal metabolic disorder characterized by micro-architectural deterioration of bone tissue, this leads to an increase in bone fragility and fracture risk [1]
Total calcium and ionized calcium showed a significant decrease in group I and group II compared to control group (**p ≤ 0.001), while osteocalcin, alkaline phosphatase (ALP), and periostin showed a significant increase in group I and group II compared to control group (**p ≤ 0.001)
The present study implies a potential role of periostin as a promising biomarker for the prediction of fracture risk in postmenopausal osteoporotic females
Summary
Osteoporosis is a skeletal metabolic disorder characterized by micro-architectural deterioration of bone tissue, this leads to an increase in bone fragility and fracture risk [1]. It is the most common metabolic bone disorder worldwide [2]. Bone strength is a measure of the resistance to bone fracture, which is determined by a collection of many skeletal characteristics including: composition, microarchitecture, size, and shape [4]. Bone mineral density (BMD) can be affected by positioning errors or artifacts, including osteoarthritis, fractures, and jewelry [6]. Alkaline phosphatase (ALP) that has been usually used as a biomarker for osteoporosis, isn’t specific for bone, and originates from different organs as liver and kidney [8]
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