Role of biochemical markers in the prediction of osteopenia and osteoporosis in men and women of Sikkim, India

Deepa Soibam, Amumacha T. Singh, Parvati Nandy, Ankur Baruah


Background: Osteoporosis being a silently progressing disease, the real challenge is to identify the individual at high risk of osteoporosis. Many bone turnover marker have been associated with bone loss even before occurrence of any changes in bone structure. Therefore, this study was aim to evaluate the predictive value of bone turnover marker by correlating with low bone density.

Methods: This was a case control study conducted in Sikkim Manipal Institute of Medical Sciences, India. A total of 300 subjects (150 case and 150 control) both male and female between the age group of 35- 65 were enrolled. We measure one bone formation marker serum osteocalcin and two resorption marker urine hydroxyproline (OHP) and urine N- terminal telopeptides of type I collagen (NTX). Calcaneal QUS device (GE Lunar Achilles Express heel- densitometer) was used to determine the bone density.

Results: A significant difference of the bone markers i.e. hydroxyproline, NTx and osteocalcin were observed between cases and control of men and women with P<0.001. These variables statistically significantly predicts bone density with F (3, 71) = 5,671, P= 0.002, R2= 0.193 and F (3, 71) = 5.292, P= 0.002, R2= 0.183 in women and men respectively.

Conclusions: Study showed that bone turnover markers are able to predict low bone mass. Resorption markers NTx and OHP were the main predictor in men whereas OHP and formation marker Osteocalcin in women. Therefore, BTM measurement along with BMD can provide useful information about the changes in the bone mass which will help to predict the risk of osteoporosis.


Bone turnover marker (BTM), Hydroxyproline (OHP), N-terminal telopeptides of type I collagen (NTX), Osteocalcin

Full Text:



Szulc P, Bouxsein ML. Overview of osteoporosis: Epidemiology and clinical management, IOF vertebral fracture initiative. 2011;(pt1):1-65.

Durosier C, Hans D, Krieg MA, Schott AM. Prediction and discrimination of osteoporotic hip fracture in postmenopausal women. J Clin Densit. 2006 Oct 1;9(4):475-95.

Nishizawa Y, Nakamura T, Ohata H, Kushida K, Gorai I, Shiraki M. Committee on the guidelines for the use of biochemical markers of bone turnover in osteoporosis: Japan Osteoporosis Society. Guidelines on the use of biochemical-markers of bone turnover in osteoporosis. J Bone Miner Meta. 2001;19:338-44.

Demers LM. Clinical usefulness of markers of bone degradation and formation. Scand J Clin Invest. 1997;57(Suppl 227):12-20.

Vergnaud P, Lunt M, Scheidt-Nave C, Poor G, Gennari C, Hoszowski K, et al. Is the predictive power of previous fractures for new spine and non-spine fractures associated with biochemical evidence of altered bone remodeling? The EPOS study. European Prospective Osteoporosis Study. Clin Chim Acta. 2002;322:121-32.

Sathian B, Sreedharan J, Baboo SN, Sharan K, Abhilash ES, Rajesh E. Relevance of sample size determination in medical research. Nepal J Epidemiol. 2010;1(1):4-10.

Newman RE, Logan MA. The determination of hydroxyproline. J Biol Chem. 1950;184:299-306.

Kumar A, Devi SG, Mittal S, Shukla DK, Sharma S. A hospital based study of biochemical markers of bone turnovers & bone mineral density in north Indian women. The Indian J Med Res. 2013 Jan;137(1):48.

Garnero P, Sornay‚ÄźRendu E, Claustrat B, Delmas PD. Biochemical markers of bone turnover, endogenous hormones and the risk of fractures in postmenopausal women: the OFELY study. J Bone Mineral Res. 2000 Aug 1;15(8):1526-36.

Ravn P, Rix M, Andreassen H, Clemmensen B, Bidstrup M, Gunnes M. High bone turnover is associated with low bone mass and spinal fracture in postmenopausal women. Calcif Tissue Int. 1997;60:255-60.

Lee AJ, Hodges S, Eastell R. Measurement of osteocalcin. Annals Clin Biochem. 2000 Jul;37(4):432-46.