Plasma periostin associates significantly with non-vertebral but not vertebral fractures in postmenopausal women: Clinical evidence for the different effects of periostin depending on the skeletal site

다국어 초록 (Multilingual Abstract)

<P><B>Abstract</B></P> <P><B>Background</B></P> <P>Periostin is preferentially expressed by the periosteum, which mainly covers the long bones. Therefore, the role of periostin in osteoporotic fracture (OF) may differ depending on bone type. We performed a case–control study to investigate whether periostin can serve as a predictor of OF risk, particularly after dividing OFs into non-vertebral and vertebral fractures.</P> <P><B>Methods</B></P> <P>Among 532 consecutive postmenopausal women not taking any drug or without any disease that could affect bone metabolism, 133 cases with OF (<I>i.e.</I>, non-vertebral and/or vertebral fractures) and 133 age- and body mass index-matched controls were enrolled. Non-vertebral (<I>i.e.</I>, forearm, humerus, hip, and pelvis; n=81) and morphological vertebral (n=62) fractures were identified by an interviewer-assisted questionnaire and lateral thoracolumbar radiographs, respectively. Bone mineral density (BMD) and plasma periostin levels were also measured.</P> <P><B>Results</B></P> <P>Plasma periostin was markedly higher in subjects with non-vertebral fracture than their controls even after adjustment for BMD and potential confounders (<I>P</I> =0.006). Each standard deviation increment of plasma periostin was associated with a multivariable-adjusted odds ratio of 1.59 for non-vertebral fracture. The odds for non-vertebral fracture were 2.48-fold higher in subjects in the highest periostin tertile compared with those in the lowest periostin tertile (95% confidence interval=1.10–5.61). However, associations between plasma periostin and vertebral fracture were not observed, regardless of the adjustment model used. Consistently, plasma periostin levels were inversely associated with proximal femur BMD (<I>P</I> =0.007 to 0.030) but not lumbar spine BMD. In subgroup analyses, plasma periostin had no correlation with the levels of classical bone turnover markers.</P> <P><B>Conclusions</B></P> <P>Plasma periostin may be a potential biomarker of the risk of OF, especially in non-spinal skeletal sites, such as the limbs, rather than spine.</P> <P><B>Highlights</B></P> <P> <UL> <LI> Subjects with osteoporotic non-vertebral fracture showed markedly higher plasma periostin levels than their controls. </LI> <LI> Subjects in the highest periostin tertile had a 2.48-fold higher risk of non-vertebral fracture. </LI> <LI> Vertebral fracture did not associate with plasma periostin levels, regardless of the adjustment model used. </LI> <LI> Consistently, plasma periostin levels were inversely associated with proximal femur BMD but not lumbar spine BMD. </LI> </UL> </P>