Bone turnover markers and prediction of fractures
Osteoporosis is characterized by compromised bone mass and strength, predisposing to an increased risk of fracture. Increased bone metabolism has been suggested to be a risk factor for fracture. The aim of this study [1] was to evaluate whether baseline bone turnover markers are associated with long-term incidence of fracture in a population-based sample of 1040 women who were 75 years old (Malmö OPRA study). Bone resorption was assessed by serum tartrate–resistant acid phosphatase 5b (S-TRACP5b) and serum C-terminal cross-linked telopeptides of type I collagen (S-CTX-I). Bone formation was assessed by serum bone-specific alkaline phosphatase (S-bALP) and three assays for different molecular forms of osteocalcin. Serum intact osteocalcin (S-OC[1–49]), serum total osteocalcin (S-TotalOC), and serum -carboxylated osteocalcin (S-cOC). Urinary osteocalcin (U-OC) was also measured. Bone markers were measured at baseline and 1-year follow-up visit.
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Vertebral fracture status and the WHO risk factors for predicting osteoporotic fracture risk
Vertebral fractures are the most common osteoporotic fracture, and patients with prevalent vertebral fractures have a greater risk of future fractures. However, radiographically determined vertebral fractures are not identified as a distinct risk factor in the World Health Organization (WHO) fracture risk assessment tool. The objective of this study [1] was to evaluate and compare potential risk factors including morphometric spine fracture status and the WHO risk factors for predicting 5-y fracture risk. It was hypothesized that spine fracture status provides prognostic information in addition to consideration of the WHO risk factors alone. A randomly selected, population-based community cohort of 2761 noninstitutionalized men and women > 50 y of age living within 50 km of one of nine regional centers was enrolled in the Canadian Multicentre Osteoporosis Study (CaMOS), a prospective and longitudinal cohort study following subjects for 5 y. Prevalent and incident spine fractures were identified from lateral spine radiographs. Incident nonvertebral fragility fractures were determined by an annual, mailed fracture questionnaire with validation, and nonvertebral fragility fracture was defined by investigators as a fracture with minimal trauma.
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QFractureScores for predicting risk of osteoporotic fracture
The objective of this study [1] was to develop and validate two new fracture risk algorithms (QFractureScores) for estimating the individual risk of osteoporotic fracture or hip fracture over 10 years. For this purpose, the authors used a prospective open cohort study with routinely collected data from 357 general practices to develop the scores and from 178 practices to validate the scores, in England and Wales. Participants were 1 183 663 women and 1 174 232 men aged 30 to 85 in the derivation cohort, who contributed 7 898 208 and 8 049 306 person years of observation, respectively. There were 24 350 incident diagnoses of osteoporotic fracture in women and 7934 in men, and 9302 incident diagnoses of hip fracture in women and 5424 in men. The main outcome measures were first (incident) diagnosis of osteoporotic fracture (vertebral, distal radius, or hip) and incident hip fracture recorded in general practice records.
FRAX and risk of Vertebral Fractures: the Fracture Intervention Trial
The validity of the WHO 10-yr probability of major osteoporotic fracture model (FRAX) for prediction of vertebral fracture has not been tested. The authors of a recent study [1] analyzed how well FRAX for major osteoporotic fractures (with and without femoral neck BMD) predicted the risk of vertebral fracture. They also compared the predictive validity of FRAX, femoral neck BMD, and prevalent vertebral fracture detected by radiographs at baseline alone or in combination to predict future vertebral fracture. They analyzed data from the Fracture Intervention Trial placebo groups (3.8-y follow-up, n = 3221).
Is QUS or DXA better for predicting the 10-Year absolute risk of fracture?
Although quantitative ultrasound (QUS) is known to be correlated with BMD and bone structure, its long-term predictive power for fractures in comparison with DXA is unclear. The authors of a recent study [1] examined this in a sample of men and women in the European Prospective Investigation into Cancer (EPIC)-Norfolk who had both heel QUS and hip DXA between 1995 and 1997.
 Download here the slide set presented by Prof. Friedlander, on Thursday, November 10th. |
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