Increased Bone Resorption Is Associated With Higher Mortality in Community-Dwelling Men >= 50 Years of Age: The MINOS Study

Low BMD, high concentration of 17 beta-estradiol (17 beta E2), and decreased level of 25-hydroxycholecalciferol [25(OH)D] predict mortality. Our hypothesis is that high levels of biochemical bone turnover markers (BTMs) are independent predictors of mortality in home-dwelling men. In 781 men >= 50 yr of age followed up prospectively for 10 yr. we studied the association of BTMs with mortality after adjustment for confounders including BMD, major osteoporotic fractures, and concentrations of 17 beta E2 and 25(OH)D. Men who died had lower BMD and higher BTM levels. In multivariate models, mortality was higher in men with low BMD (lowest quartile) at the total hip, whole body, and ultradistal radius (HR = 1.49-1.70, p < 0.05). After exclusion of the first 3 yr, higher levels (fourth quartile) of bone resorption markers (free and total deoxypyridinoline and urinary and serum type I collagen C-telopeptide) predicted mortality in multivariate models adjusted for age, BMI, smoking habits, alcohol intake, physical performance and activity, comorbidities, total hip BMD, major osteoporotic fractures, creatinine clearance, season, and concentrations of 17 beta E2 and 25(OH)D (HR = 1.58-2.44, p < 0.05-0.001). In conclusion, in older community-dwelling men, increased bone resorption markers levels predicted mortality regardless of age and other confounders. Thus, in older men, high bone resorption may reflect poor current health status and poor aging. J Bone Miner Res 2009;24:1116-1124. Published online on December 29, 2008; doi: 10.1359/JBMR.081251