Elevated Bone Turnover Markers are Associated with Distal Radius Fractures in Pre-menopausal Women: Level 3 Evidence

Abstract

Grant received from: OREF Resident Research Project Grant There is no financial information to disclose. Vitamin D deficiency and increased bone turnover markers (BTM) are associated with an increased risk of fragility fractures. We hypothesized that young patients with distal radius fractures (DRF) would have lower levels of 25-hydroxyvitamin D (25(OH)D) and increased levels of serum BTMs compared to controls without fracture. Premenopausal women with DRF (n = 20) were prospectively enrolled and compared to age-matched individuals without a fracture (n = 20). Outcome measures included serum levels of 25(OH)D, parathyroid hormone (PTH), markers of bone formation (osteocalcin [OC], N-terminal extension propeptide of type I collagen [P1NP], and bone-specific alkaline phosphatase [BSAP], and markers of bone resorption (C-terminal telopeptide of type-I collagen [CTX-1]). Associations between BTM and DRF were assessed with conditional logistic regression and the utility of markers for fracture prediction was assessed with a receiver operator characteristic (ROC) analysis. The fracture group and control group were comparable in terms of age, body mass index, and age at menarche. Fracture patients had higher levels of OC (23.09 ± 6.86 versus 17.23 ± 8.19 ng/mL, mean difference = 6.01 ng/mL, 95%CI = 1.32 - 10.70) and P1NP (72.15 ± 25.80 versus 51.99 ± 24.18 ng/mL, mean difference = 20.44 ng/mL, 95% CI = 4.53 - 36.34) and trended toward higher levels of CTX (0.43 ± 0.21 versus 0.32 ± 0.21 ng/mL, mean difference = 0.10, 95% CI = -0.01 - 0.22). The levels of 25(OH)D, PTH, and BSAP were similar between groups. Conditional logistic regression revealed independent associations between DRF and CTX (OR = 7.4 per SD increase, 95% CI = 1.3 - 43.6, P = 0.026), and OC (OR = 2.4 per SD increase, 95% CI = 1.0 - 5.8, P = 0.043). Associations between DRF and P1NP (OR = 4.78 per SD increase, 95% CI = 0.97 - 23.66, P = 0.055) and BSAP (OR = 3.16 per SD increase, 95% CI = 0.96 - 10.37, P = 0.058) trended towards significance (Table 1). Serum 25(OH)D and PTH were not associated with DRF. ROC analyses demonstrated moderate performance for OC, P1NP, BSAP and CTX in predicting DRF (Figure 1). •25(OH)D levels were not associated with DRF in pre-menopausal women.•Patients with DRF had increased levels of BTMs of formation and resorption.•Women with increased levels of OC and CTX were at higher risk of fracture.•BTMs may be helpful in predicting fractures in pre-menopausal women.View Large Image Figure ViewerDownload Hi-res image Download (PPT)