Low bone mineral density is a strong risk factor for fractures in the older woman. Biochemical markers of bone turnover may predict fracture risk independently of bone mineral density. High levels of bone resorption markers are associated with increased risk of fracture in both retrospective and prospective studies, although the evidence for bone formation markers and fracture risk is equivocal. For example, the risk of fracture is increased up to two-fold in women with elevated levels of several markers of bone resorption. Prediction models have been developed to predict the 10–year risk of fracture using bone mineral density and biochemical markers of bone turnover and these could prove very useful in clinical practice.
. CummingsSRMeltonLJ. Epidemiology and outcomes of osteoporotic fractures. Lancet2002; 359: 1761–1767.
2.
. PolsHAFelsenbergDHanleyDA. Multinational, placebo-controlled, randomized trial of the effects of alendronate on bone density and fracture risk in postmenopausal women with low bone mass: results of the FOSIT study. Foxamax International Trial Study Group. Osteoporos Int1999; 9: 461–468.
3.
. DelmasPDEnsrudKEAdachiJD. Efficacy of raloxifene on vertebral fracture risk reduction in postmenopausal women with osteoporosis: four-year results from a randomized clinical trial. J Clin Endocrinol Metab2002; 87: 3609–3617.
4.
. HarrisST. Risedronate treatment and extended fracture protection in postmenopausal women. Clin Exp Rheumatol2001; 19: 625–626.
5.
. McClungMRGeusensPMillerPD. Effect of risedronate on the risk of hip fracture in elderly women. Hip Intervention Program Study Group. N Engl J Med2001; 344: 333–340.
6.
. CummingsSRBlackDMNevittMC. Bone density at various sites for prediction of hip fractures. The Study of Osteoporotic Fractures Research Group. Lancet1993; 341: 72–75.
7.
. RavnPFledeliusCRosenquistC. High bone turnover is associated with low bone density in bone pre- and postmenopausal women. Bone1996; 19: 291–298.
8.
. IngleBMHaySMBottjerHMEastellR.Changes in bone mass and bone turnover following distal forearm fracture. Osteoporos Int1999; 10: 399–407.
9.
. AkessonKVergnaudPGineytsE. Impairment of bone turnover in elderly women with hip fracture. Calcif Tissue Int1993; 53: 162–169.
10.
. EastellRRobinsSPColwellA. Evaluation of bone turnover in type I osteoporosis using biochemical markers specific for both bone formation and bone resorption. Osteoporos Int1993; 3: 255–260.
11.
. CheungCKPanesarNSLauE. Increased bone resorption and decreased bone formation in Chinese patients with hip fracture. Calcif Tissue Int1995; 56: 347–349.
12.
. LuisettoGBottegaFNardiAZiliottoD.Decrease of bone formation in adult women with fragility fractures. Maturitas1997; 28: 59–67.
13.
. Mezquita-RayaPMunoz-TorresMde DiosLJ. Performance of COLIA1 polymorphism and bone turnover markers to identify postmenopausal women with prevalent vertebral fractures. Osteoporos Int2002; 13: 506–512.
14.
. MeltonLJIKhoslaSAtkinsonEJ. Relationship of bone turnover to bone density and fracture. J Bone Miner Res1997; 12: 1083–1091.
15.
. CloosPAFledeliusC.Collagen fragments in urine derived from bone resorption are highly racemized and isomerized: a biological clock of protein aging with clinical potential. Biochem J2000; 345: 473–480.
16.
. KawanaKTakahashiMHoshinoHKushidaK.Comparison of serum and urinary C-terminal telopeptide of type I collagen in aging, menopause and osteoporosis. Clin Chim Acta2002; 316: 109–115.
17.
. VergnaudPLuntMScheidt-NaveC. Is the predictive power of previous fractures for new spine and non- spine fractures associated with biochemical evidence of altered bone remodelling? The EPOS study. Clin Chim Acta2002; 322: 121–132.
18.
. AkessonKVergnaudPDelmasPDObrantKJ. Serum osteocalcin increases during fracture healing in elderly women with hip fracture. Bone1995; 16: 427–430.
19.
. BenhamouCLTourlierDGauvainJB. Calciotropic hormones in elderly people with and without hip fracture. Osteoporos Int1995; 5: 103–107.
20.
. AkessonKLjunghallSGardsellP. Serum osteocalcin and fracture susceptibility in elderly women. Calcif Tissue Int1993; 53: 86–90.
21.
. AkessonKLjunghallSJonssonB. Assessment of biochemical markers of bone metabolism in relation to the occurence of fracture: a retrospective and prospective population-based study of women. J Bone Miner Res1995; 10: 1823–1829.
22.
. GarneroPHausherrEChapuyMC. Markers of bone resorption predict hip fracture in elderly women: the EPIDOS Prospective Study. J Bone Miner Res1996; 11: 1531–1538.
23.
. GarneroPSornay-RenduEClaustratBDelmasPD. Biochemical markers of bone turnover, endogenous hormones and the risk of fractures in postmenopausal women: the OFELY study. J Bone Miner Res2000; 15: 1526–1536.
24.
. RossPDKressBCParsonRE. Serum bone alkaline phosphatase and calcaneus bone density predict fractures: a prospective study. Osteoporos. Int2000; 11: 76–82.
25.
. BauerDCBlackDMEnsrudK. Serum markers of bone turnover and fractures of the hip and spine: A prospective study. J Bone Miner Res1999; 14(Suppl 1): S146 (abstract).
26.
. WeelMSeibelMJHofmanA. Which fractures are associated with high bone resorption in elderly women: The Rotterdam study. J Bone Miner Res1999; 14(Suppl 1): S160 (abstract).
27.
. van DaelePLSeibelMJBurgerH. Case-control analysis of bone resorption markers, disability, and hip fracture risk: the Rotterdam study. BMJ1996; 312: 482–483.
28.
. ChapurlatRDGarneroPBreartG. Serum type I collagen breakdown product (serum CTX) predicts hip fracture risk in elderly women: the EPIDOS study. Bone2000; 27: 283–286.
29.
. ClowesJAHannonRAYapTS. Effect of feeding on bone turnover markers and its impact on biological variability of measurements. Bone2002; 30: 886–890.
30.
. GarneroPCloosPSornay-RenduE. Type I collagen racemization and isomerization and the risk of fracture in postmenopausal women: the OFELY prospective study. J Bone Miner Res2002; 17: 826–833.
31.
. TrompAMOomsMEPopp-SnijdersC. Predictors of fractures in elderly women. Osteoporos Int2000; 11: 134–140.
32.
. PlantalechLGuillaumontMVergnaudP. Impairment of gamma-carboxylation of circulating osteocalcin (bone gla protein) in elderly women. J Bone Miner Res1991; 6: 1211–6.
33.
. SzulcPChapuyMCMeunierPJDelmasPD. Serum Undercarboxylated Osteocalcin Is a Marker of the Risk of Hip Fracture in Elderly Women. J Clin Invest1993; 91: 1769–74.
34.
. SzulcPChapuyMCMeunierPJDelmasPD. Serum undercarboxylated osteocalcin is a marker of the risk of hip fracture: a three year follow-up study. Bone1996; 18: 487–8.
35.
. VergnaudPGarneroPMeunierPJ. Undercarboxylated osteocalcin measured with a specific immunoassay predicts hip fracture in elderly women:the EPIDOS study. J Clin Endocrinol Metab1997; 82: 719–724.
36.
. HannonRABlumsohnAEllisJV. Long term variability of markers of bone turnover in postmenopausal women. 1998Bone: 23 (Suppl 5): S159 (abstract).
37.
. GarneroPDargent-MolinaPHansD. Do markers of bone resorption add to bone mineral density and ultrasonographic heel measurement for the prediction of hip fracture in elderly women? The EPIDOS prospective study. Osteoporos Int1998; 8: 563–569.
38.
. JohnellOOdenADe LaetC. Biochemical indices of bone turnover and the assessment of fracture probability. Osteoporos Int2002; 13: 523–526.
