Bone turnover markers in women can predict low bone mineral density


  • B. K. Agrawal Department of Biochemistry, Index Medical College, Indore, Madhya Pradesh
  • Vaishali Jain Department of Biochemistry, L.N. Medical College, Bhopal, Madhya Pradesh
  • Atul Varshney Department of Orthopedics and Traumatology, Peoples College of Medical Sciences, Bhopal, Madhya Pradesh


Bone turnover markers, Bone mineral density, Osteoporosis


Background: Morbidity and mortality associated with osteoporosis continues to be high in India due to late diagnosis. This study aims to find the difference in the levels of bone turn over markers in premenopausal and postmenopausal women, in order to assess whether these markers can be used as predictors of low bone mineral density which can develop in later life.

Methods: Study was conducted on 350 women aged 30-65 years. Women were classified into premenopausal and postmenopausal groups based on their menstrual history. Serum samples were analyzed for osteocalcin and telopeptide-C. Student’s t-test and logistic regression are used for statistical confirmations.

Results: Levels of these markers (ng/ml) were found to be lower in premenopausal women (Osteocalcin = 9.0 ± 1.0; telopeptide-C = 0.270 ± 0.099) than in postmenopausal women (Osteocalcin = 9.8 ± 1.7; telopeptide-C = 0.490 ± 0.135) and this difference was found to be significant (P <0.001) for both the markers. In both the groups, telopeptide-C made significant contribution to prediction of low BMD [(Premenopausal group - odds ratio (OR) = 2.9; 95% confidence interval (95%CI) = 1.3-6.5 and postmenopausal group - OR = 9.6; 95%CI = 6.0-13.23) but osteocalcin could not (premenopausal group - OR = 0.91; 95%CI = 0.58-1.42 and postmenopausal group - OR = 0.87; 95%CI = 0.54-1.4)]. In premenopausal women increase in telopeptide-C by a unit increased chance of developing low BMD by 2.9 times while in postmenopausal women increase in telopeptide-C by a unit increased chance of developing low BMD by 9.6 times.

Conclusion: Women with higher levels of telopeptide-C need to be identified at an early stage as it provides with an early warning of the possibility of future development of osteoporosis so that preventive measures can be taken timely.



Gupta A. Osteoporosis in India: the nutritional hypothesis. Natl Med J India. 1996;9(6):268-74.

Susan A. Calcium supplementation in postmenopausal women. Medscape Ob/Gyn & Women’s Health. 2003;8(2):460438.

Heikkinen AM, Parviainen M, Niskanen L, Komulainen M, Tuppurainen MT, Kroger H, et al. Biochemical bone markers and bone mineral density during postmenopausal hormone replacement therapy with and without vitamin D3: a prospective, controlled, randomized study. J Clin Endocrinol Metab. 1997;82:2476-82.

Woitge HW, Nave CS, Kissing C, Bruckner GL, Meyer K, Grauer A, et al. Seasonal variation of biochemical indexes of bone turnover; results of a population-based study. J Clin Endocrinol Metab. 1998;92(1):68-75.

Delmas PD, Eastell R, Garnero P, Seibel MJ, Stepan J. The use of biochemical markers of bone turnover in osteoporosis. Osteoporos Int. 2000;(Suppl 6):S2-17.

Rosen CJ, Rackoff PJ. Emerging anabolic treatment for osteoporosis. Rheum Dis Clin North Am. 2001;27:215-33.

Melton III LJ, Khosla S, Atkinson EJ, O’Fallon WM, Riggs BL. Relationship of bone turnover to bone density and fractures. J Bone Miner Res. 1997;12:1083-91.

Garnero P, Gineyts E, Riou JP, Delmas PD. Assessment of bone resorption with a new marker of collagen degradation in patients with metabolic bone disease. J Clin Endocrinol Metab. 1994;79:780-5.

Reginster JY, Henrotin Y, Christiansen C, Henriksen EG, Bruyere O, Collette J, et al. Bone resorption in post-menopausal women with normal and low BMD assessed with biochemical markers specific for telopeptide derived degradation products of collagen type I. Calcif Tissue Int. 2001;69:130-7.

Garnero P, Sornay-Rendu E, Chapuy MC, Delmas PD. Increased bone turnover in late postmenopausal women is a major determinant of osteoporosis. J Bone Miner Res. 1996;11:827-34.

Ravn P, Fledelius C, Rosenquist C, Overgaard K, Christiansen C. High bone turnover is associated with low bone mass in both pre- and postmenopausal women. Bone. 1996;19:291-8.

Lateef M, Baig M, Azhar A. Estimation of serum osteocalcin and telopeptide-C in postmenopausal osteoporotic females. Osteoporos Int. 2010;21:751-5.

Vanita R. Jagtap, Jayashree V. Ganu. Serum osteocalcin: a specific marker for bone formation in postmenopausal osteoporosis. Int J Pharm Bio Sci. 2011;1:510-7.

Knapen MH, Nieuwenhuijzen Kruseman AC, Wouters RS, Vermeer C. Correlation of serum osteocalcin fractions with bone mineral density in women during the first 10 years after menopause. Calcif Tissue Int. 1998;63:375-9.

Garton M, Martin J, New S, Lee S, Loveridge N, Milne J, et al. Bone mass and metabolism in women aged 45-55. Clin Endocrinal (Oxf). 1996;44(5):563-70.

Chowdhury S, Ashrafunnessa, Khatun S, Sarkar NR. Comparison of bone mineral density between premenopausal and postmenopausal women in Bangladesh. Bangladesh Med Res Counc Bull. 2001 Aug;27(2):48-54.

Qureshi HJ, Hamid N, Bashir MU, Saleem T, Awan AR, Ain R. Bone mineral density in premenopausal and postmenopausal women. Pak J Med Health Sci. 2011;5(1):203.

Jain V, Agrawal BK, Varshney A. Prediction of bone mineral density by age, body mass index and menopausal status in middle socioeconomic status women of urban kolar region of Bhopal. IOSR Journal of Dental and Medical Sciences. 2013;12(3):17-21.

Smeets-Goevaers C, Lesusink G, Papapoulos S, Maartens L, Keyzer J, Weerdenburg J, et al. The prevalence of low bone mineral density in Dutch perimenopausal women. Osteoporos Int. 1999;10(5):377-83.




How to Cite

Agrawal, B. K., Jain, V., & Varshney, A. (2017). Bone turnover markers in women can predict low bone mineral density. International Journal of Research in Medical Sciences, 3(4), 876–879. Retrieved from



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