S A Paul Chubb1, Elizabeth Byrnes, Laurens Manning, John P Beilby, Peter R Ebeling, Samuel D Vasikaran, Jonathan Golledge, Leon Flicker, Bu B Yeap. 1. School of Pathology and Laboratory Medicine (S.A.P.C., J.P.B., S.D.V.) and School of Medicine and Pharmacology (S.A.P.C., L.M., L.F., B.B.Y.), University of Western Australia, Crawley, Western Australia 6009, Australia; Biochemistry Department (S.A.P.C., E.B., J.P.B., S.D.V.), PathWest Laboratory Medicine, Nedlands, 6009 Western Australia, Australia; Department of Medicine (P.R.E.), Monash University, Clayton, Victoria 3146, Australia; Queensland Research Centre for Peripheral Vascular Disease (J.G.), School of Medicine and Dentistry, James Cook University, Townsville 4811, Queensland; Department of Vascular and Endovascular Surgery (J.G.), The Townsville Hospital, Townsville, Queensland 4810, Australia; and Department of Endocrinology and Diabetes (B.B.Y.), Fremantle Hospital, Fremantle 6160, Western Australia, Australia.
Abstract
CONTEXT: Reference intervals for bone turnover markers (BTMs) and relationships between BTM and fracture risk in older men are not well characterized. OBJECTIVE: The purpose of this article was to determine the reference intervals for serum total osteocalcin (tOC), undercarboxylated osteocalcin (ucOC), N-terminal propeptide of type I collagen (PINP), and collagen type I C-terminal cross-linked telopeptide (CTX-I) in healthy older men and to explore factors associated with BTMs, including hip fracture risk. PARTICIPANTS AND SETTING: We studied a population-based cohort of 4248 men aged 70 to 89 years, 4008 of whom had serum samples available for analysis. INTERVENTIONS: Morning blood samples were collected at the study visit. Comorbid conditions were assessed by questionnaire. The reference sample comprised fasting men (n = 298, median age 75.3 years [interquartile range 73.9-78.1 years) reporting excellent or very good health, without a history of diabetes, cardiovascular disease, cancer, depression, or dementia. MAIN OUTCOME MEASURES: Serum tOC, PINP, and CTX-I were estimated by automated electrochemiluminescence immunoassays, ucOC was estimated using hydroxyapatite binding, and incident hip fractures were captured from hospital admission data. RESULTS: Reference intervals for tOC, ucOC, PINP, and CTX-I were 10.2 to 41.0, 5.2 to 21.9, 18 to 129 μg/L, and 117 to 740 ng/L, respectively. tOC, ucOC and CTX-I were associated with hip fracture incidence, but after adjustment for other risk factors only tOC remained significantly associated. CONCLUSIONS: Reference intervals for BTMs in older men have been defined. tOC may be more informative for hip fracture risk in older men than CTX-I and PINP. Further studies are needed to clarify the utility of BTM reference intervals in the management of aging men at risk of osteoporosis.
CONTEXT: Reference intervals for bone turnover markers (BTMs) and relationships between BTM and fracture risk in older men are not well characterized. OBJECTIVE: The purpose of this article was to determine the reference intervals for serum total osteocalcin (tOC), undercarboxylated osteocalcin (ucOC), N-terminal propeptide of type I collagen (PINP), and collagen type I C-terminal cross-linked telopeptide (CTX-I) in healthy older men and to explore factors associated with BTMs, including hip fracture risk. PARTICIPANTS AND SETTING: We studied a population-based cohort of 4248 men aged 70 to 89 years, 4008 of whom had serum samples available for analysis. INTERVENTIONS: Morning blood samples were collected at the study visit. Comorbid conditions were assessed by questionnaire. The reference sample comprised fasting men (n = 298, median age 75.3 years [interquartile range 73.9-78.1 years) reporting excellent or very good health, without a history of diabetes, cardiovascular disease, cancer, depression, or dementia. MAIN OUTCOME MEASURES: Serum tOC, PINP, and CTX-I were estimated by automated electrochemiluminescence immunoassays, ucOC was estimated using hydroxyapatite binding, and incident hip fractures were captured from hospital admission data. RESULTS: Reference intervals for tOC, ucOC, PINP, and CTX-I were 10.2 to 41.0, 5.2 to 21.9, 18 to 129 μg/L, and 117 to 740 ng/L, respectively. tOC, ucOC and CTX-I were associated with hip fracture incidence, but after adjustment for other risk factors only tOC remained significantly associated. CONCLUSIONS: Reference intervals for BTMs in older men have been defined. tOC may be more informative for hip fracture risk in older men than CTX-I and PINP. Further studies are needed to clarify the utility of BTM reference intervals in the management of aging men at risk of osteoporosis.
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