Perhaps higher risk of fracture if low BMD plus low vitamin D
Diagnosis of Low Bone Mass Density: Serological versus Radiological Methods
Int J Gen Med . 2022 Jul 1;15:5937-5945. doi: 10.2147/IJGM.S357417. eCollection 2022.
Osama A Shaikhomar 1, Abdelghnay H Abdelghnay 2 3, Haitham M H Qutob 4
Context: Bone remodeling comprises balanced coupling of bone formation and resorption, and low bone mineral density (BMD) demonstrates high rates of bone resorption. Osteoporosis is a chronic asymptomatic disease with fragile bones and impending risk of fractures mediated by minor trauma. Whereas bone mineralization and integrity are determined by calcium and vitamin D, specific serum markers such as bone specific alkaline phosphatase (ALP) and osteocalcin (OC) play a vital role in bone formation.
Materials and methods: Serum calcium, vitamin D, ALP, and OC levels were measured in 2,145 Saudi students aged 18-22 years at Umm Al-Qura University. The BMD was measured by dual-energy X-ray absorptiometry (DEXA), and the findings were statistically evaluated. The following statistics were utilized in the analysis: the SPSS software was used to record, tabulate, and statistically evaluate the results.
Results: Low BMD cases accounted for 27.46% of all cases investigated, with considerably higher serum calcium, bone-specific ALP, and OC levels compared to control cases, but significantly lower serum vitamin D levels. In low BMD instances, there was no association between serum markers and DEXA findings.
Conclusion: Serum indicators by themselves may be useful for screening and predicting patients at risk of osteoporosis, as well as assessing treatment response. The combination of serum markers and DEXA measures is more effective in detecting low BMD.
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Although the high serum levels of bone formation markers indicate newly-formed bones, those bones were found to be less mineralized which might negatively alter the bone microarchitecture and strength and predispose to the risk of fracture. 38,40
Therefore, serum markers might not be used for the diagnosis of low BMD. Instead, they may be used for prediction of people at risk of developing fractures, especially in postmenopausal women and for evaluation of the response to osteoporosis therapy. 28,29
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