Association between bone turnover markers and FRAX predicted fracture risk in Chinese adults: a cross-sectional study

Our study investigated the associations between bone turnover markers (BTMs) and bone mineral density (BMD) and fracture risk over the next 10 years. The objective of the study was to evaluate the potential effects of BTMs in fracture risk.

Our cross-sectional study enrolled 580 participants (380 postmenopausal women and 200 men over the age of 50). All participants completed a questionnaire and dual-energy X-ray absorptiometry examination. We obtained BMD values for the lumbar spine, femoral neck, and total hip joint and biochemical indicators such as creatinine, type 1 procollagen N-terminal propeptide (P1NP), and beta cross-linked C-telopeptide of type 1 collagen (β-CTX). Furthermore, we used an online fracture risk assessment tool (FRAX) to calculate the probability of major osteoporotic fractures (PMOF) and hip fractures (PHF) over the next 10 years. We divided the participants into three groups based on the BMD T-score criteria: normal bone mass group (T-score ≥ - 1.0 SD), osteopenic group (- 2.5 SD < T-score < - 1.0 SD), and osteoporotic group (T-score ≤ - 2.5 SD). We compared differences in BTMs, BMD, and fracture risks among the three groups. Additionally, we evaluated differences in indicators between males and females and explored risk factors associated with BMD and fracture risk.

Postmenopausal women showed higher bone turnover markers, osteoporosis prevalence, and fracture risks compared to men. In a multivariate stepwise regression analysis, we identified P1NP was positively correlated with fracture risk for both PMOF (β = 0.087, p = 0.005) and PHF (β = 0.135, p < 0.001) over the next 10 years. In the logistic regression analysis, after adjusting for sex, we found that for every standard deviation increase in P1NP, the future 10-year risk of fractures increased by approximately 5.2-fold in the high PMOF group and 5.6-fold in the high PHF group.

Our study demonstrated that elevated serum P1NP levels were associated with increased fracture risk over a 10-year period. These findings suggested that serum P1NP measurement could be a valuable complementary tool alongside BMD measurements and FRAX assessments for identifying individuals at high risk of fracture.