Sains Malaysiana 42(8)(2013): 1191–1200

Bone Resorption Marker Status of Pre and Postmenopausal Malay Women in Kelantan and

Its Corresponding Risk Factors

(Status Petanda Resorpsi Tulang dalam Kalangan Wanita Melayu Pra dan Pascamenopaus

di Kelantan dan Faktor Risiko yang Sepadan)

Hermizi Hapidin*

Biomedicine Programme, School of Health Sciences, Universiti Sains Malaysia, Health Campus

16150 Kubang Kerian, Kelantan, Malaysia

Hawa Mahmood & Sakinah Harith

Dietetic Programme, School of Health Sciences, Universiti Sains Malaysia, Health Campus

16150 Kubang Kerian, Kelantan, Malaysia

Received: 20 Jun 2012 /Accepted: 16 December 2012

ABSTRACT

Menopause is the most prevalent cause of accelerated bone loss in women. Biochemical markers of bone resorption can be used clinically to predict future bone loss. This study aimed to determine the level of bone resorption markers in healthy pre and postmenopausal Malay women and determine their association with the risk. A total of 150 healthy women were recruited for this study (51 pre and 99 postmenopausal subjects). Data on socioeconomic, lifestyle habit and clinical were gained by personal interview. Fasting serum was collected to measure both C-telopeptide (CTx) and N-telopeptide (NTx) of type 1 collagen. Both markers were highly correlated with each other (r=0.568, p<0.001). Both intra- and inter-assay coefficient of variations (CV) of NTx were higher than those of CTx (8% and 12% vs 6% and 5%). The mean CTx values of pre and postmenopausal subjects were comparable with the expected values (0.2833 (0.1769) ng/mL and 0.4323 (1.851) ng/mL compared with 0.287 and 0.438 ng/mL, respectively). The NTx value for premenopausal subjects were higher than the expected values (15.2 (8.10) compared to 12.6 (3.20) nM BCE). The median was 19.929 nM BCE. The mean CTx and NTx levels of postmenopausal subjects were significantly lower than premenopausal subjects (p<0.05). The risk factors for bone resorption in this population were duration of menopause, marital status, body mass index (BMI), physical activity and education level. In conclusion, postmenopausal women showed a higher bone resorption, indicating higher bone loss. Increasing education and physical activity intervention might be effective to ensure better health in Malaysian older population.

Keywords: Bone resorption marker (NTx, CTx); Malay; postmenopausal; premenopausal

ABSTRAK

Menopaus adalah faktor utama yang mempercepatkan kadar hakisan tulang dalam kalangan wanita. Petanda biokimia bagi hakisan tulang boleh digunakan secara klinikal untuk meramal kehilangan jisim tulang. Objektif kajian ini adalah untuk mengenal pasti aras resorpsi tulang wanita pra dan pascamenopaus serta mengenal pasti faktor risiko resorpsi tulang dalam golongan ini. Seramai 150 subjek terlibat dalam kajian ini (51 pra dan 99 pascamenopaus). Data sosioekonomi, gaya hidup dan data klinikal diperoleh melalui temu bual secara individu. Serum subjek ketika berpuasa digunakan untuk menentukan petanda resorpsi tulang N- dan C- ‘terminal telopeptides of type 1 collagen’ (NTx dan CTx). Kedua-dua petanda resorpsi tulang ini mempunyai perkaitan yang tinggi (r=0.568, p<0.001). Kedua-dua ‘intra’ dan ‘inter-assay’ pekali ubah (CV) untuk NTx adalah lebih tinggi berbanding CTx (8% dan 12% vs 6% dan 5%). Nilai min CTx wanita pra- dan pascamenopaus dalam kajian ini sebanding dengan nilai jangkaan (0.2833 (0.1769) ng/mL dan 0.4323 (1.851) ng/mL berbanding 0.287 dan 0.438 ng/mL). Nilai NTx bagi wanita pramenopaus adalah lebih tinggi berbanding nilai jangkaan (15.2 (8.10) berbanding 12.6 (3.20) nM BCE). Nilai median adalah 19.929 nM BCE. Nilai min CTx dan NTx bagi subjek pascamenopaus adalah lebih tinggi berbanding subjek pramenopaus (p<0.05). Faktor risiko resorpsi tulang bagi populasi ini adalah tempoh pascamenopaus, status perkahwinan, indeks jisim badan (BMI), aktiviti fizikal dan tahap pendidikan (p<0.05). Kesimpulannya, wanita pascamenopaus mempunyai aras petanda resorpsi tulang yang menggambarkan kadar kehilangan tulang yang lebih tinggi. Meningkatkan tahap pendidikan dan intervensi aktiviti fizikal mungkin merupakan langkah yang berkesan bagi memastikan kesihatan tulang yang lebih baik dalam kalangan populasi warga tua di Malaysia.

Kata kunci: Melayu; pascamenopaus; petanda resorpsi tulang (NTx, CTx); pramenopaus

REFERENCES

Adami, S., Bianchi, G. & Brandi, M.L. 2008. Bonturno study group determinants of bone turnover markers in healthy premenopausal women. Calcif Tissue Int. 82: 341-347.

Avis, N.E., Brambilla, J.D., Vass, K. & Mcinlay, J. 1991. The effect of widowhood on health: A prospective analysis from the Massachusetts women’s health study. Soc. Sci. Med. 33: 1063-1070.

Baca, E.A., Ulibarri, V.A., Scariano, J.K., Ujah, I. & Bassi, A. 1999. Increased serum levels of N-telopeptides (NTx) of bone collagen in postmenopausal Nigerian women Calcif Tissue Int. 65: 125-128.

Bacon, W. & Hadden, W. 2000. Occurrence of hip fractures and socioeconomic position. J. Aging Health 12: 193-203.

Bischoff-Ferrari, H.A., Dawson-Hughes, B., Baron, J.A., Burckhardt, P., Li, R., Spiegelman, D., Specker, B., Orav, J.E., Wong, J.B., Staehelin, H.B., O’Reilly, E., Kiel, D.P. & Willett, W.C. 2007. Calcium intake and hip fracture risk in men and women: A meta-analysis of prospective cohort studies and randomized controlled trials. Am. J. Clin. Nutr. 86: 1780-1790.

Brennan, S.L., Pasco, J.A., Urquhart, D.M., Oldenburg, B., Hanna, F. & Wluka, A.E. 2009. The association between socioeconomic status and osteoporotic fracture in population-based adults: A systematic review. Osteoporosis International 20: 1487-1497.

Cassandra, A. & Thomas, A. 2001. The bone organ system: Form and function. 2nd ed. In Osteoporosis, edited by Robert, M. F., David, F. & Jennifer, K. Elsevier Inc.

Cauley, J.A., Parimi, N., Ensrud, K.E., Bauer, D.C., Cawthon, P.M., Cummings, S.R., Hoffman, A.R., Shikany, J.M., Barrett- Connor, E. & Orwoll, E. 2010. Serum 25-hydroxyvitamin D and the risk of hip and nonspine fractures in older men. Journal of Bone and Mineral Research 25: 545-553.

Caulfield, M. & Reitz, R. 2004. Biochemical markers of bone turnover and their utility in osteoporosis. Med. Lab. Obs. Apr 36: 34-37.

Chee, W., Suriah, A., Zaitun, Y., Chan, S., Yap, S. & Chan, Y. 2002. Dietary calcium intake in postmenopausal Malaysian women: Comparison between the food frequency questionnaire and three-day food records. Asia Pac. J. Clin. Nutr. 11: 142-146.

Cho, K., Cederholm, T. & Lo¨kk, J. 2008. Calcium intake in elderly patients with hip fractures. Food & Nutrition Research DOI: 10.3402/fnr.v52i0.1654.

Chopin, F., Biver, E., Funck-Brentan, T., Bouvard, B., Coiffier, G., Garnero, P. & Thomas, T. 2011. Prognostic interest of bone turnover markers in the management of postmenopausal osteoporosis. Joint Bone Spine DOI: 10.1016/j.jbspin.2011.05.004.

Clemens, J.D., Herrick, M.V., Singer, F.R. & Eyre, D.R. 1997. Evidence that serum NTx (collagen-type I Ntelopeptides) can act as an immunochemical marker of bone resorption. Clinical Chemistry 43: 2058-2063.

Cummings, S.R., Nevitt, M.C., Browner, W.S., Stone, K., Fox, K.M., Ensrud, K.E., Cauley, J., Black, D. & Vogt, T.M. 1995. Risk factors for hip fracture in white women. The New England Journal of Medicine 332: 767-773.

Cutler, D.M. & Lleras-Muney, A. 2006. Education and health: Evaluating theories and evidence. NBER working paper series. National Bureau of Economic Research.

Desai, M., Bhanuprakash, K. & Khatkhatay, M.U.D. 2007. Age-related changes in bone turnover markers and ovarian hormones in premenopausal and postmenopausal Indian women. J Clin. Lab. Anal. 21: 55-60.

Farahmand, B.Y., Perrson, P.G., Michealsson, K., Baron, J.A., Parker, M.G. & Ljunghall, S. 2000. Socioeconomic status, marital status and hip fracture risk: A population-based case-control study. Osteoporos Int. 11: 803-808.

Fox, M. & Cole, N. 2004. Nutrition and health characteristics of low-income populations: volume I, food stamp program participants and nonparticipants. Contract No.: E-FAN No. (04014-1).

Garnero, P., Borel, O. & Delmas, P.D. 2001. Evaluation of a fully automated serum assay for C-terminal cross-linking telopeptide of type I collagen in osteoporosis. Clinical Chemistry 47: 694-702.

Guillemant, J.A., Accarie, C.M., Gueronniere, V.D.L. & Guillemant, S.E. 2003. Different acute responses of serum type I collagen telopeptides, CTX, NTX and ICTP, after repeated ingestion of calcium. Clinica. Chimica. Acta 337: 35-41.

Guilley, E., Herrmann, F., Rapin, C-H., Hoffmeyer, P., Rizzoli, R. & Chevalley, T. 2011. Socioeconomic and living conditions are determinants of hip fracture incidence and age occurrence among community-dwelling elderly. Osteoporosis International 22: 647-653.

Heikkinen, A., Parviainen, M., Niskanen, L., Komulainen, M., Tuppurainen, M.T. & Kröger, H.S.S. 1997. Biochemical bone markers and bone mineral density during postmenopausal hormone replacement therapy with and without vitamin D3: A prospective, controlled, randomized study. J. Clin. Endocr. Soc. 82: 2476-2482.

Huguet, N., Kaplan, M.S. & Feeny, D. 2008. Socioeconomic status and health-related quality of life among elderly people: Results from the Joint Canada/United States survey of health. Soc. Sci. Med. 66: 803-810.

Ismail, N.M. & Technical Working Group on Nutritional Guidelines. 2005. Recommended Nutrient Intakes for Malaysia. National Coordinating Committee on Food and Nutrition (NCCFN). Ministry of Health. Putrajaya.

Jokinen, H., Pulkkinen, P., Korpelainen, J., Heikkinen, J. & Keinanen-Kiukaanniemi, S. 2010. Risk factors for cervical and trochanteric hip fractures in elderly women: A population-based 10-year follow-up study. Calcified Tissue International 87: 44-51.

Khir, A.S., Pheng, C.S., Abdullah, B.J., Tiong, C.W., Goh, E., Ismail, F., Lee, H.F., Kiong, L.J., Weng, L.T., Hing, L.H., Mumtaz, M., Yusof, M.D.C., Ismail, N.M.N., Parameshwaran, K., Damodaran, P., Nazaruddin, G.R., Srinivas, P., Chee, W., Sim, Y.S. & Ali, Z.B.M. 2006. Clinical practice guidelines on management of osteoporosis 2006. Malaysian Osteoporosis Society.

Kraenzlin, M. & Seibel, M. 2006. Measurement of biochemical markers of bone resorption, In Dynamics in Bone and Cartilage Metabolism, edited by Seibel, M., Robins, S. & Bilezikian, J. San Diego, CA: Academic Press.

Kruger, M.C., Kruger, L.M., Wentzel-Viljoen, E. & Kruger, A. 2011. Urbanization of black South African women may increase risk of low bone mass due to low vitamin D status, low calcium intake, and high bone turnover. Nutrition Research 31: 748-758.

Lai, J.K.C., Lucas, R.M., Clements, M.S., Roddam, A.W. & Banks, E. 2010. Hip fracture risk in relation to vitamin D supplementation and serum 25-hydroxyvitamin D levels: A systematic review and meta-analysis of randomised controlled trials and observational studies. BMC Public Health 10: 331.

La-or Chailurkit, B.O., Piaseu, N., Saetung, S. & Rajatanavin, R. 2001. Biochemical markers of bone turnover and response of bone mineral density to intervention in early postmenopausal women: An experience in a clinical laboratory. Clin. Chem. 47: 1083-1088.

Lau, E.M.C., Lee, J.K., Suriwongpaisal, P., Saw, S.M., De, S.D., Khir, A. & Sambrook, P. 2001. The incidence of hip fracture in four asian countries: The asian osteoporosis study (AOS) Osteoporos Int. 12: 239-243.

Lee, J.K. & Khir, A.S.M. 2007. The incidence of hip fracture in Malaysians above 50 years of age: Variation in different ethnic groups. APLAR Journal of Rheumatology 10: 300-305.

Lim, P., Ong, F., Adeeb, N., Seri, S., Noor-Aini, M., Shamsuddin, K., Hapizah, N., Mohamed, A., Mokhtar, A. & Wan, H. 2005. Bone health in urban midlife Malaysian women: Risk factors and prevention. Osteoporos. Int. 16: 2069-2079.

Loh, K., Shong, K., Lan, S., Lo, W. & Woon, S. 2008. Risk factors for fragility fracture in Seremban district, Malaysia: A comparison of patients with fragility fracture in the orthopedic ward versus those in the outpatient department. Asia Pac. J. Public Health 20: 251-257.

Nilas, L. & Christiansen, C. 1988. Rates of bone loss in normal women: Evidence of accelerated trabecular bone loss after the menopause. Eur. J. Clin. Invest. 18: 529-534.

Malaysian Dietary Guidelines. 2010. Technical Working Group on Nutritional Guidelines. Ministry of Health. Putrajaya.

Mithal, A., Wahl, D.A., Bonjour, J.P., Burckhard, P., Dawson- Hughes, B., Eisman, J.A., El-Hajj Fuleihan, G., Josse, R.G., Lips, P. & Morales-Torres, J. IOF Committee of Scientific Advisors (CSA) Nutrition Working Group. 2009 Global vitamin D status and determinats of hypovitiminosis D. Osteoporosis International 20(11): 1807-1820.

Papp, A.E.D., Bone, H.G., Caulfield, M.P., Kagan, R., Buinewicz, A., Chen, E., Rosenberg, E. & Reitz, R.E. 2007. A cross-sectional study of bone turnover markers in healthy premenopausal women. Bone 40: 1222-1230.

Parakrama, C. & Clive, R. 1998. Concise Pathology. 3rd ed. Appleton & Lange.

Parker, N., Bugdayci, D., Tekdos, D. & Dere, C.B.K. 2009. Relationship between bone turnover and bone density at the proximal femur in stroke patients. Journal of Stroke and Cerebrovascular Diseases 18: 139-143.

Perez, R.C., Galan, F.G. & Dilsen, G. 1993. Risk factors for hip fracture in Spanish and Turkish women. Bone 14: 69-72.

Qvist, P., Christgau, S., Pedersen, B.J., Schlemmer, A. & Christiansen, C. 2002. Circadian variation in the serum concentration of C-terminal telopeptide of type I collagen (Serum CTx): Effects of gender, age, menopausal status, posture, daylight, serum cortisol, and fasting. Bone 31: 57-61.

Rahman, S.A., Chee, W., Yassin, Z. & Chan, S. 2004. Vitamin D status among postmenopausal Malaysian women. Asia Pac. J. Clin. Nutr. 13: 255-260.

Scarianoa, J.K., Garry, P.J., Montoya, G.D., Wilson, J.M. & Baumgartner, R.N. 2001. Critical differences in the serial measurement of three biochemical markers of bone turnover in the sera of pre- and postmenopausal women. Clin. Biochem. 34: 639-644.

Suriah, A., Zainorni, M., Shafawi, S., Suraya, S.M., Zarina, N., Zainuddin, W.W. & Zalifah, M. 1996. Nutrient intake among elderly in southern Peninsular Malaysia. Mal. J. Nutr. 2: 11-19.

Tortora, G. & Derrickson, B. 2006. Principles of Anatomy and Physiology. 11th ed. New Jersey: John Wiley & Sons, Inc.

Wang, M.C. & Dixon, L.B. 2006. Socioeconomic influences on bone health in postmenopausal women: Findings from NHANES III, 1988-1994. Osteoporos Int. 17: 91-98.

Xie, B., Gillilanda, F.D., Li, Y.F. & Rockett, H.R. 2003. Effects of ethnicity, family income, and education on dietary intake among adolescents. Preventive Medicine 36: 30-40.

Yoshimura, N., Muraki, S., Oka, H., Kawaguchi, H., Nakamura, K. & Akune, T. 2011. Changes in serum levels of biochemical markers of bone turnover during 10 years among Japanese men and women: Associated factors and birth-cohort effect. The Taiji Study. The Japanese Society for Bone and Mineral Research 29: 699-708.

Zingmond, D.S., Soohoo, N.F. & Silverman, S.L. 2006. The role of socioeconomic status on hip fracture. Osteoporos Int. 17: 1562-1568.

*Corresponding author; email: hermizi@kck.usm.my