Determinants of bone health in elderly Japanese men: study design and key findings of the Fujiwara-kyo Osteoporosis Risk in Men (FORMEN) cohort study

BACKGROUND@#The Fujiwara-kyo Osteoporosis Risk in Men (FORMEN) study was launched to investigate risk factors for osteoporotic fractures, interactions of osteoporosis with other non-communicable chronic diseases, and effects of fracture on QOL and mortality.@*METHODS@#FORMEN baseline study participants (in 2007 and 2008) included 2012 community-dwelling men (aged 65-93 years) in Nara prefecture, Japan. Clinical follow-up surveys were conducted 5 and 10 years after the baseline survey, and 1539 and 906 men completed them, respectively. Supplemental mail, telephone, and visit surveys were conducted with non-participants to obtain outcome information. Survival and fracture outcomes were determined for 2006 men, with 566 deaths identified and 1233 men remaining in the cohort at 10-year follow-up.@*COMMENTS@#The baseline survey covered a wide range of bone health-related indices including bone mineral density, trabecular microarchitecture assessment, vertebral imaging for detecting vertebral fractures, and biochemical markers of bone turnover, as well as comprehensive geriatric assessment items. Follow-up surveys were conducted to obtain outcomes including osteoporotic fracture, cardiovascular diseases, initiation of long-term care, and mortality. A complete list of publications relating to the FORMEN study can be found at https://www.med.kindai.ac.jp/pubheal/FORMEN/Publications.html .

Analysis of serum levels of bone turnover biochemical markers in patients with SAPHO syndrome / 中华风湿病学杂志

Objective:To evaluate the changes and significance of bone turnover makers in patients with SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis) syndrome.Methods:Thirty-two patients with SAPHO syndrome who were treated in the department of rheumatology and immunology of Beijing Jishuitan Hospital were collected as the study group, and 28 healthy subjects were taken as the control group. The clinical data and bone turnover markers were compared between the two groups, and the correlation between the bone turnover markers and disease-related indicators were analyzed. Two independent samples were comp-ared by using t test (in line with normal distribution) and rank sum test (not in line with normal distribution). The results of more than two independent samples were compared by one-way analysis of variance, and the correlation between two variables was analyzed by Spearman. Results:Compared with the clinical data of the two groups, hemoglobin (Hb) of the study group [128(122, 140) g/L] was significantly lower than that of the control group [139(125, 154) g/L]( U=306.5, P<0.05), but alkaline phosphatase (ALP) [75.00(66.00, 85.75) mmol/L] was significantly higher than that of the control group [56.00(48.50, 63.25) mmol/L] ( U=153, P<0.01). The comparison of bone turnover markers showed that serum total procollagen type 1 amino-terminal propeptide (tP1NP)[52.51(41.72, 86.11) ng/ml], Beta C-terminal cross-linked telopeptides of type Ⅰ collagen (β-CTX) [0.57(0.39, 0.72) ng/ml] and OC [(20±8) ng/ml] levels in the study group were significantly higher than those in the control group [34.91(28.97, 42.80) ng/ml, 0.34(0.27, 0.49) ng/ml, (15±4) ng/ml] ( U=183, P<0.01; U=223, P<0.01; t=3.180, P<0.01). There was no significant difference in 25-(OH)VD 3 between the two groups [14.73(12.25, 19.23) ng/ml, 16.72(11.74, 20.92) ng/ml] ( P>0.05). The serum biochemical markers of bone turnover were not related to spine, bone and joints involvement. The grouping results of the number of joints involved showed that there were significant differences in serum osteocalcin (OC) levels of patients ( F=3.684, P<0.05), and the more the number of joints involved, the lower the OC value. Correlation analysis showed that serum tP1NP ( r=0.805), β-CTX ( r=0.460) and OC levels were positively correlated with each other(all P<0.01). Levels of tP1NP, β-CTX, OC, and 25-(OH)VD 3 in the study group were not related to age, course of disease, and neutrophil granulocyte (all P>0.05). However, β-CTX was positively correlated with C-reactive protein (CRP) ( r=0.392, P<0.05), and OC was positively correlated with erythrocyte sedimentation rate (ESR) ( r=0.475, P<0.05). Conclusion:The levels of tP1NP, β-CTX and OC in patients with SAPHO syndrome are significantly increased. Levels of β-CTX and OC can reflect the severity of patients' inflammation. The level of OC is related to the number of joint involvement of the patient.

Clinical significance of monitoring bone turnover markers changes before and after growth hormone treatment of prepubertal children with idiopathic short stature / 中华实用儿科临床杂志

Objective To detect the levels and study the clinical significance of serum procollagen type Ⅰ amino-terminal propeptide (PINP) and β-C-telopeptides of type Ⅰ collagen (β-CTX) as bone turnover markers in recombinant human growth hormone (rhGH) treatment of prepuberty idiopathic short stature (ISS) children.Methods Forty patients of ISS (18 boys and 22 girls) had been collected and treated with GH 0.15 IU/(kg · d) injection every night.Serum levels of PINP,β-CTX,insulin-like growth factor 1 (IGF-1) and insulin-like growth factor binding protein 3 (IGFBP3) were measured by electrochemiluminescence immunoassay in ISS before treatment and after 3,6 months,and they were also measured in 50 healthy children of the healthy control group,and the height,weight,body mass index,height standard difference score (HtSDS),bone age and growth rate were recorded.Results (1) In ISS group,the serum level of PINP[(479.51 ± 134.61) μg/L] was lower than that of the healthy control group [(651.31 ± 212.41) μg/L],the level of β-CTX[(0.84 ± 0.33) μg/L] was higher than that of the healthy control group [(0.50 ± 0.15) μg/L].The differences were statistically significant (t =2.276,-2.709,all P ＜ 0.05).(2) The serum levels of PINP and β-CTX had no significant difference in 18 boys and 22 girls before and after GH treatment (P＞0.05) of ISS.After 3 months of GH treatment,the serum levels of PINP[(736.15 ± 156.59) μg/L] and β-CTX [(1.08 ± 0.27) μg/L] were higher than those before treatment in 40 cases,and the difference was statistically significant (t =4.736,2.497,all P ＜ 0.05),as the increase of PINP was particularly significant.HtSDS (-2.95 ±0.43),compared with before treatment (-2.69 ± 0.58),was significantly different (t =2.714,P ＜ 0.05).However,after 6 months of GH treatment,the levels of PINP[(860.90 ±254.59) μg/L] and β-CTX[(0.94 ±0.32) μg/L] increased slowly (t =1.366,-0.831,all P ＞ 0.05).HtSDS (-2.51 ± 0.54) showed no significant difference (t =1.609,P ＞ 0.05) compared with 3 months of treatment.(3) The serum level of PINP was positively correlated with IGF-1 and IGFBP3 (r =0.636,0.673,all P ＜ 0.05),and there was no correlation with β-CTX (r =0.336,P ＞0.05).PINP and β-CTX had significant correlation with HtSDS (r =0.655,0.782,all P ＜ 0.05).Conclusions The serum PINP and β-CTX as bone turnover markers in serum can be used as one of the early supplementary indicators to predict GH response of ISS.

Evaluation of Osteopontin in Combination with Bone Turnover Markers for the Assessment of Osteoporosis in Postmenopausal Women.

Aims: Osteoporosis, a disease characterized by low bone mass and microarchitectural deterioration of bone tissue, has an important impact on the lives of postmenopausal women, owing to the increased risk of fractures. Although bone mineral density (BMD) is the standard criteria used for the diagnosis of osteoporosis, but BMD provides a slow and static picture of skeleton whereas, the biochemical markers of bone turnover (BTM) can provide dynamic status of bone remodeling and rapid measurement of skeletal metabolism. Osteopontin (OPN), a glycoprotein has been implicated in bone remodeling by activating the resorption process. Combination of osteopontin with classical bone turnover markers can enhance the confidence of detecting osteoporosis and predicting fracture risk. Study Design: Cross-sectional study. Place and Duration of Study: Department of Pathology, Quaid-e-Azam Medical College, Pakistan from 1st July 2015 to 15th September 2015. Methodology: We included 120 females (60 postmenopausal, age >45 years and 60 from childbearing age 25-45 years) and excluded all conditions affecting bone metabolism. Enzyme-linked immunosorbent assay technique was used to measure levels of bone markers in serum. Results: Bone markers were significantly higher in postmenopausal group of patients. Osteopontin was found to be positively correlated with osteocalcin (r=0.82), bALP (r=0.76), CTX (r=0.62) and DPD (r=0.49) and it was negatively correlated with BMD lumbar spine (r= -0.71) indicating a significant correlation (p<0.0001). The osteopontin and osteocalcin combination showed highest sensitivity (94%) and specificity (88%), closely followed by that of osteopontin and bone alkaline phosphatase combination. Conclusion: High levels of osteopontin in postmenopausal women are associated with low BMD, raised levels of bone turnover markers and fractures. When used in combination with other bone turnover markers, it can provide an accurate assessment of osteoporosis and fracture risk.

On the relationship between bone mineral density and bone turnover markers in subjects aged 80 and above / 中华内分泌代谢杂志

Objective To investigate the value of bone turnover markers(BTMs) in forecasting the variance of bone mineral density (BMD) by studying the relationships between BTMs and BMD in persons aged 80 and above.Methods A sample of 1 509 subjects aged 80 and above was recruited.All subjects underwent BMD measurement by dual energy X-ray absorptiometry,and BTMs (C-telopeptide of type 1 collagen,N-terminal propeptide of type 1 procolagen,osteocalcin) measurements.The relationships among all the BTMs,and between BMD and BTMs were analysed.Results In subjects aged 80 and above,the relationships among BTMs were moderately positive(all P＜0.05).In men aged 80 and above,BMDs were inversely associated with BTMs(all P＜0.05),and in women,BMDs were inversely associated with osteocalcin (P＜ 0.05).Conclusions The clinical significance of BTMs in persons aged 80 and above indicates bone resorption when BTMs are raised.In men aged 80 and above any of BTMs may be selected to evaluate bone metabolism ; while in women,osteocalcin should be selected.

Effects of a 'Drug Holiday' on Bone Mineral Density and Bone Turnover Marker During Bisphosphonate Therapy

BACKGROUND: Recently long-term safety of bisphosphonate raises issues about the duration of therapy. We examined the effects of a drug holiday (DH) on bone mineral density (BMD) and bone turnover markers. METHODS: In Korean, 125 women of 50 years of age or older with T-score or =5 years started DH in 2006. Lumbar (L1-4), left femoral neck, total BMD, serum parameter (beta-crossLaps [CTx], phosphorus, total calcium, total alkaline phosphatase), and urinary parameter (calcium/creatinine ratio) were measured before, the time of starting, and after DH. RESULTS: After DH, lumbar, femoral neck and total BMD did not change significantly (0.757+/-0.093-->0.747+/-0.102, P=0.135, 0.567+/-0.079-->0.560+/-0.082, P=0.351, 0.698+/-0.008-->0.691+/-0.090 g/cm2, P=0.115, respectively). Serum CTx and total alkaline phosphatase were increased significantly (0.205+/-0.120-->0.791+/-0.44 ng/mL, P60.42+/-15.543 IU/L, P=0.001, respectively). Urinary calcium/creatinine ratio increased significantly (0.132+/-0.076-->0.156+/-0.093, P=0.012). CONCLUSIONS: A DH could be cautiously considered in patients with long-term use of bisphosphonate if there is a concern about severe suppression of bone turnover with respect to long-term use because insignificant changes of BMD and significant increase of bone turnover markers are shown during the period.

The Usefulness of Bone Turnover Marker as a Predictive Factor In Osteopenic Postmenopausal Women / 대한정형외과연구학회지

PURPOSE: To assess the relationship between biochemical bone turnover marker and bone mineral density(BMD) and to evaluate the predictive role of biochemical bone marker in postmenopausal osteopenic woman. MATERIALS AND METHODS: Ninety two postmenopausal women (50-65 years old), who have the T-score from -1.0 to -2.5 by the dual-energy X-ray absorptiometry (DEXA), were examined consecutively with BMD of the lumbar spine and biochemical bone turnover marker including urine Cross-linked N-telopeptide of type I collagen (u-NTX), urine deoxy-pyridinoline (u-DPD), serum Cross-linked C-telopeptide of type I collagen (s-CTX), serum bone-specific alkaline phosphatase (s-BAP), serum osteocalcin (s-OC) for six months. We evaluated the relation between the changes in the biochemical markers and the rate of bone loss. RESULTS: Seventy four postmenopausal women completed this study. All biochemical bone turnover marker and BMD at one time point including the baseline and the end point did not show any significant correlation. Another longitudinal study found no significant correlation between the baseline biochemical bone turnover marker and the change in lumbar spine BMD. The other study showed significant correlation between the changes in s-CTX/s-OC and the change in lumbar spine BMD (p=0.04, 0.03). The changes of u-NTX and s-OC were larger in the group of aggravation in BMD (p=0.032, 0.041). CONCLUSION: The relationship between bone turnover marker and BMD at one time point was not clear. The predictive role of baseline bone turnover marker was limited to predict the magnitude of changes in lumbar BMD in untreated osteopenic individuals. The changes of s-OC showed significant predictive role in the bone loss in osteopenic postmenopausal women.

Bone turnover markers in multiple myeloma / 白血病·淋巴瘤

Objective To study the role of bone turnover markers in multiple myeloma(MM)bone disease.Methods Thirty-eight MM patients were studied.Serum and urine samples were taken before,after 3 months and 6 months therapy.Serum samples of tartrate resistant acid phosphatage isoform-5b(sTRACP-5b),bonespesific alkaline phosphatase(sBAP),osteocslcin(sOC),urine samples of N-telopeptides of type Ⅰ collagen(NTX)were measured.Results Urine NTX concentrations were significantly higher in newly diagnosed and relapsed or refractory patients than that in pleateum patients and controls.serum TRACP-5b concentrations were significantly higher in newly diagnosed and relapsed or refractory patients than that in controls.There were no statistical significance compared with pleateum patients.Serum BAP concentrations were significantly lower than that in pleateum patients and controls.Serum OC concentrations were not statistically significant among the newly diagnosed patients,relapsed or refractory patients,pleateum patients and control.In newly diagnosed patients.urine NTX levels were significantly higher in stage Ⅲ than that in stage Ⅰ/Ⅱ,serum BAP levels were significantly lower in stage Ⅲ than that in stage Ⅰ/Ⅱ.There was a positive relationship between urine NTX and serum TRACP-5b in newly diagnosed patients.Urine NTX levels were significantly decreased,and serum BAP levels were significantly increased after 3 cycles effective therapy.There was no change in serum TRACP-5b and OC.Urine NTX and serum TRACP-5b were significantly diseased,serum BAP and OC were significantly increased after 6 cycles of effective therapy.But bone lesions on X-ray did not diminish at that time.Conclusion There is a closely relationship between bone turnover markers and bone lesions in MM.The bone turnover markers may be useful in monitoring MM progress and therapy.

The Change of Bone Metabolism in Stroke Rat

OBJECTIVE: The purpose of this study was to investigate the effect of ischemic stroke on bone metabolism. METHOD: Female Sprague-Dawley rats (12 weeks old, n=48) were randomly divided into 4 separate groups; sham operation group (group A), stroke group (group B), ovariectomy group (group C), and stroke-ovariectomy group (group D). Two weeks after performing ovariectomy, cerebral ischemia was induced. The bone mineral density (BMD) and osteocalcin and carboxy-terminal telopeptide (CTX) were measured on three periods: the day before ischemia and 1 and 3 weeks post-stroke. All data were statistically analyzed. RESULTS: One week after cerebral ischemia, lumbar spine BMD of group B and D although statistically insignificant showed a lower BMD score in comparison to group A and C, respectively. Three weeks after ischemia, compared to group C, the BMD score of lumbar spine in group D was reduced significantly (p<0.05). At one week post-stroke, compared with group A and C, the value of osteocalcin in group B and D were reduced significantly, respectively (p<0.05). One and three weeks after ischemia, the CTX value in all groups showed no statistical difference. CONCLUSION: The authors concluded that ischemic stroke affected bone metabolism by decreasing osteoblastic activity in the early phase of stroke rat.

The Relationship between Sex Hormones and Bone Turnover Markers in Adult Men

BACKGROUND: Bone mass changes in men is related to age, BMI, sex hormones and other factors. In prior studies, bone markers were negatively correlated with bone mineral density, free testosterone, and estrogen and was positively correlated with SHBG. In a study of sex hormones and bone markers in Korean men estradiol was negatively correlated with deoxypyridinoline. In this study, the relationship of testosterone, estradiol, calculated free testosterone, FEI and SHBG to bone turnover markers in adult men were investigated. METHODS: This was a cross-sectional study of 184 men who had undertaken a health screening program in one general hospital in Bundang from November, 2001 to February, 2003. We surveyed information concerning the past medical history, current medication, alcohol consumption amount per week and smoking amount by means of self questionnaire records. Serum total testosterone, estradiol, SHBG and osteocalcin, alkaline phosphatase were measured at a fasting state. Urine was tested for deoxypyridinoline. Free testosterone was calculated using albumin, SHBG, and total testosterone level. RESULTS: Deoxypyridinoline adjusted by age, BMI was negatively correlated with FEI (r=-0.17, P=0.020) and was positively correlated with smoking amount (r=0.20 P= 0.007). Osteocalcin was negatively correlated with calculated free testosterone and ethanol consumption amount (r=-0.186, P=.0.12, r=-0.186, P=0.012). Multiple regression analysis showed that the most powerful factor influencing deoxypyridinoline was smoking amount (R2= 0.046), followed by FEI, BMI, and the one influencing osteocalcin was BMI (R2=0.050), ethanol amount and calculated free testosterone. After adjusting for age, BMI, drinking amount and smoking amount FEI shown to be a predictor of deoxypyridinoline (beta=-0.08, p<0.01, R2=0.101). After adjusting for age, BMI, and drinking amount calculated free testosterone was shown to be a predictor of osteocalcin (beta=-0.570, P<0.01, R2=0.130) in multiple regression model. CONCLUSIONS: In adult men, FEI shown to be a predictor of deoxypyridinoline and calculated free testosterone to be a predictor of osteocalcin as an independent variable.

Relationship between Parathyroid Hormone, Vitamin D and Bone Turnover Markers in Korean Postmenopausal Women / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to evaluate the relationship between parathyroid hormone (PTH), vitamin D status, bone mineral density (BMD) and bone turnover markers in Korean postmenopausal women. METHODS: The subjects were 263 healthy postmenopausal women recruited in Seoul, Korea. The research was performed from January to March, 1999. Serum PTH level was measured with immunoradiometric assay (IRMA). Serum 25 (OH) vitamin D concentration was measured by radioimmunoassay (RIA) for the evaluation of vitamin D nutritional status. The averages of BMD were attained from the 2nd and 3rd lumbar spine. Two serum levels of bone turnover markers such as osteocalcin and N- telopeptide were also measured by IRMA and enzyme linked immunosorbent assay (ELISA) respectively. RESULTS: Severe, moderate, mild vitamin D deficiency and normal vitamin D status groups were found in 16 (6.1%), 94 (35.7%), 127 (48.3%), and 26 (9.9%) subjects respectively. Among the four groups, no significant differences were found in terms of age, weight, height, bady mass index (BMI). The serum vitamin D levels were 3.18 +/- 1.5 ng/ml, 7.8 +/- 1.4 ng/ml, 13.9 +/- 2.7 ng/ml 25.2 +/- 1.3 ng/ml in severe, moderate, mild, vitamin D deficiency and normal vitamin D status group respectively. Serum PTH levels were 28.6 +/- 14.9 pg/ ml, 22.7 +/- 10.4 pg/ml, 19.5 +/- 12.9 pg/ml, 15.1 +/- 10.3 pg/ml in severe, moderate, mild vitamin D deficiency and normal vitamin D, respectively, and a siginificant difference was found (p<0.05). In comparison with the normal vitamin D group, PTH concentration level was significantly increased by 90.1%, 50.4%, 29.4%, in severe, moderate, mild vitamin D deficiency groups respectively (p<0.05). The serum PTH concentration and 25 (OH) vitamin D were inversely related (r=-0.219, p<0.05). The correlations between the serum PTH level and other factors, such as age, weight, height, BMI, BMD, and bone turnover markers, were insignificant. CONCLUSION: Korean postmenopausal women showed an increase in serum PTH levels in case of vitamin D deficiency, and about 90% of women were suffering from vitamin D deficiency. Therefore, it is recommendable to prescribe the supplemental vitamin D for the most of Korean postmenopausal women.

The effect and the mechanism of bortezomib on bone disease in patients with multiple myeloma / 中国实用内科杂志

Objective To study whether bortezomib combined with dexamethasone can relieve bone pain of patients with multiple myeloma and to see whether bortezomib have effect on bone metabolism through determining the concentration of bone turnover marks.Methods 59 cases of patients with multiple myeloma treated with BD and 38 cases of patients treated with VADM were observed before and after chemotherapy to compare the alleviation of bone pain,the improvement of the ability to move and the occurrence of skeletal related events between the two groups.The plasma from 25 patients were collected before and after chemotherapy when they were in hospital each time and the concentrations of TRACP-5b,BALP and DKK1 in plasma were determined by ELISA.Results BD group was better than VADM group in the rate of alleviation of bone pain,the improvement of the ability to move and the incidence of skeletal related events(75.7% vs 50%,64.9% vs 20.8% and 13.8% vs 57.8%,all P

The Effect of Bone Marrow Transplantation on Bone Mineral Metabolism: 2 - Year Prospective Study / 대한내분비학회지

BACKGROUND: Loss of bone mass is usually detected after bone marrow transplantation (BMT), especially during the early post-transplant period. But little is known about the long-term effects of BMT on bone mineral metabolism. METHODS: We have investigated prospectively 12 patients undergoing BMT (4 autologous, 8 allogeneic) for hematologic diseases (8 leukemia, 3 SAA, 1 MDS). Serum concentrations of calcium, phosphorus, creatinine, gonadotropins, sex hormones and bone turnover markers (osteocalcin and ICTP) were measured. The samples were collected before BMT and 1, 2, 3, 4, and 12 weeks, 6 months and 1, 2 years thereafter. Bone mineral density (BMD) was measured with DEXA (Dual Energy X-ray Absorptiometry) before BMT, 1 year and 2 year after BMT. In patients with amenorrbea, hormone replacement therapy was started from around 1 year after BMT RESULTS: 1. The mean bone loss in the lumbar spine, calculated as the percent change from the baseline to the level at 1 year and 2 year was 7.3% and 1.9%, respectively. The mean bone loss in the total proximal femur from the baseline to the level at 1 year and 2 year was 8.0% and 8.3% respectively. 2. The serum ICTP increased progressively until four weeks after BMT. Thereafter, it decreased gradually to reach basal values after one year and thereafter no more change until 2 year. Serum osteocalcin decreased progressively until three weeks after BMT. After that, it increased and reached basal values after 3 months. Osteocalcin increased at 6 month transiently but thereafter, it decreased to the level of slightly above basal value at 2 year. 3. Patients who were treated with TBI or pateints with GVHD had a tendency of lower BMD at l year and 2 year after BMT than those of patients without TBI or GVHD. 4. Eight out of nine women went into a menopausal state immediately after BMT and remained amenorrhea, evidenced by high gonadotropins and low estradiol levels. In contrast to women, gonadotropins and testosterone levels were not changed significantly in men after BMT. CONCLUSION: The rapid impairment of bone formation and the increase in bone resorption, as shown by the biochemical markers in this study, might play a role in bone loss after BMT. The efficacy of HRT for the correction of hypogonadism and bone loss was evidenced by 2 year BMD which was much more increased compared to 1 year BMD, especially in vertebra.

The Correlation of Combined Biochemical Markers of Bone Turnover for Bone Mineral Density in Postmenopausal women / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to assess the usefulness of combination of bone formation and resorption markers in predicting the bone mineral density (BMD), and to see there was a correlation with years since menopause(YSM) and BMD according to the combination of bone turnover marker and bone sites. METHOD: BMD and bone turnover marker(serum osteocalcin and urine deoxypyridinoline) was assessed in 266 healthy postmenopausal women at the time of first visiting in postmenopausal clinic and were divided into six groups based on combination of their reference range in bone turnover markers. RESULTS: We evaluated the discrimination power of the combination of bone turnover marker in assessing BMD among the six gorups, there was no statistically significant difference in BMD of Lumbar2-4 and Femur (Neck, Ward. Trochanter). In case of both higher than reference range of osteocalcin and deoxypyridinoline(D-pyr), BMD of Lumbar2-4 and Femur in postmenopausal women had a negative correlation with YSM. In case of higher than normal reference range of D-pyr and within the reference range of osteocalcin, BMD of Femur had a negative correlation with YSM. CONCLUSION: Thus each bone site had its own good combination of bone marker levels to correlate the BMD according to the YSM.