Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Bone Turnover Markers Not Linked to Hip Fractures

J Bone Miner Res; ePub 2018 Jun 19; Crandall, et al

Results of a recent study do not support the utility of serum C‐terminal telopeptide of type I collagen (CTX) level or procollagen type 1 aminoterminal propeptide (PINP) level to predict hip fracture risk in postmenopausal women. Researchers determined the associations of serum CTX and serum PINP with hip fracture risk among postmenopausal women aged 50 to 79 years at baseline. They performed a prospective case‐control study (400 cases, 400 controls) nested in the Women's Health Initiative Observational Study, which enrolled participants at 40 US clinical centers. Included were women with incident hip fracture not taking osteoporosis medication; hip fractures were confirmed using medical records. Untreated controls were matched by age, race/ethnicity, and date of blood sampling. Serum CTX and serum PINP were analyzed on 12‐hour fasting blood samples. They found:

  • The main outcome measure was incident hip fracture risk (mean follow‐up 7.13 years).
  • After adjustment for body mass index, smoking, frequency of falls, history of fracture, calcium and vitamin D intake, and other relevant covariates, neither serum CTX level nor serum PINP level was statistically significantly associated with hip fracture risk.


Crandall CJ, Vasan S, La Croix A, et al. Bone turnover markers are not associated with hip fracture risk: A case‐control study in the Women's Health Initiative. [Published online ahead of print June 19, 2018]. J Bone Miner Res. doi:10.1002/jbmr.3471.

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