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Review
. 2019 Feb 28;14(1):68.
doi: 10.1186/s13018-019-1100-6.

Reference markers of bone turnover for prediction of fracture: a meta-analysis

Aixian Tian  1 , Jianxiong Ma  1 , Kaiqiang Feng  2 , Zhaojie Liu  1 , Lei Chen  3 , Haobo Jia  4 , Xinlong Ma  5
Affiliations
Free PMC article
Review

Reference markers of bone turnover for prediction of fracture: a meta-analysis

Aixian Tian et al. J Orthop Surg Res. .
Free PMC article

Abstract

Objective: To explore whether bone turnover biomarkers (BTMs), i.e., C-terminal telopeptide of type I collagen (CTX) and procollagen type I aminoterminal propeptide (PINP), are associated with fracture.

Methods: We searched electronic database including PubMed, Embase and Cochrane Library, and the reference lists of relevant articles published from inception to August 22, 2018. An updated meta-analysis was performed to assess the prediction value of CTX and PINP in fracture.

Results: Nine articles met our inclusion criteria and were included in the meta-analysis. The crude and adjusted effect size between PINP and fracture were extracted from two and five studies, respectively. PINP was not associated with fracture incidence without adjusting covariates (crude GR, 1.03; 95% CI, 0.91-1.17). After adjusting for potential confounders, PINP demonstrated a significant positive association with fracture (adjusted GR, 1.28; 95% CI, 1.15-1.42). In the subgroup analysis of studies after adjusting covariates, there were significant associations in women. Both the crude (1.16, 95%CI, 1.04-1.20) and adjusted GR (1.20, 95%CI, 1.05-1.37) shown positive relationships between CTX and fracture, which were extracted from four and six studies, separately. The sensitivity analysis confirmed the stability of the results. In the subgroup analysis of studies after adjusting covariates, there were significant associations in the subgroups of elderly, female, and hip fracture patients.

Conclusions: Our results indicate a statistically significant but modest association between BTMs (s-PINP or s-CTX) and future fracture risk after adjusting for BMD and clinical risk factors. The causal relationship between the two clinical conditions requires future validation with more standardized studies.

Registration number: CRD42018107879.

Keywords: BTMs; CTX; Fracture; PINP.

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Conflict of interest statement

Ethics approval and consent to participate

Not applicable.

Consent for publication

Written informed consent was obtained from all patients for data publication, including images.

Competing interests

The authors declare that they have no competing interests.

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Figures

Fig. 1
Fig. 1
PRISMA flow diagram for the study selection process
Fig. 2
Fig. 2
Forest plot of the a crude and b adjusted associations between PINP and fracture
Fig. 3
Fig. 3
Forest plot of the a crude and b adjusted associations between CTX and fracture
Fig. 4
Fig. 4
Sensitivity analysis of adjusted GR: a PINP, b CTX
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