A multicenter study has dug into the issue of whether two recommended serum markers (CTX and PINP) are truly indicative of hip fracture risk among postmenopausal women.
Shock: Common Test for Fracture Risk Not Predictive?
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#hipfractureSecondary#boneturnover
Surprisingly, they may not be.
The study, “Bone Turnover Markers Are Not Associated With Hip Fracture Risk: A Case‐Control Study in the Women’s Health Initiative,” appears in the June 19, 2018 edition of the Journal of Bone and Mineral Research.
Carolyn J. Crandall, M.D., professor of medicine at the David Geffen School of Medicine at University of California, Los Angeles, and co-author on the study told OTW, “Clinicians often order serum bone turnover markers to estimate fracture risk. However, the evidence to inform this practice was lacking, especially regarding whether carefully-collected fasting morning serum levels of the two recommended serum markers (CTX and PINP) predict hip fracture risk in older women.”
“Fasting morning serum levels of the two recommended bone turnover markers, CTX and PINP, were not significantly associated with hip fracture risk among elderly women (mean age 70 years).”
“These results do not support the utility of serum CTX level or PINP level for predicting hip fracture risk in older women who are not being treated with osteoporosis medication.”
“As much as it might feel theoretically useful to measure these markers, it is premature to measure these bone turnover marker levels in order to predict hip fracture risk in elderly women who are not being treated with osteoporosis medication.”
“Our research, based on a follow-up of 7 years with very careful documentation of fractures and other osteoporosis risk factors, does not support this practice. More research is needed regarding whether the markers are useful for predicting non-hip fractures.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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