The Association Of Lifestyle Factors And Medications With Bone Turnover Markers In Older Irish Adults: Results From The TUDA Study

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Abstract Background Normal bone undergoes continuous remodelling through resorption and formation. However, an imbalance in this process leads to loss in bone mineral density. Several factors including lifestyle, biophysical and medications influence bone turnover. We aimed to assess the impact of these factors on bone turnover markers (BTMs in older Irish adults. Methods Participants were from the TUDA study of older Irish adults aged>60. Individuals using antiresorptive or anabolic therapies were excluded. BTMswere serum TRAB5b (a resorption marker) and bone alkaline phosphatase (BAP) as a formation marker. The relationship between lifestyle factors (smoking, alcohol consumption), biophysical (age, sex, vitamin D status, timed up and go, body mass index (BMI), diabetes) and medications (steroids, thiazides, statins, ARB’s, PPIs) with BTMswere explored in multinomial regression adjusting for all factors in the model. Results 1764 participants, mean age 70.0 years, 49.0% female. Higher serum TRAP5b was independently predicted by female sex (p<0.001), lower BMI (p<0.001), lower vitamin D (p<0.001) and PPI use (p=0.0005). Conversely, lower TRAB5b was identified in users of thiazides (p<0.001) and ARBs (p=0.003). Predictors of higher BAP were female sex (p<0.001), lower vitamin D (p<0.001), higher PTH (p<0.001) and PPI use (P =0.002) while lower BAP was found in users of thiazides (p<0.001) and steroids (p=0.030). Conclusion As expected lower BMI and lower vitamin D status predicted increased bone resorption. As bone formation is coupled to resorption, lower vitamin D also predicted increased BAP. Of interest, PPI’s were associated with higher bone turnover suggesting a mechanism for increased fracture risk. Conversely, low bone turnover with thiazides may explain their positive association found elsewhere with BMD. ARB’s were selectively associated with lower bone resorption and may be beneficial for bone health. Finally, steroid users had lower bone formation as identified elsewhere as a mechanism for causing bone loss.

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