ORIGINAL RESEARCH article
Front. Endocrinol.
Sec. Bone Research
This article is part of the Research TopicRecent Advances in the Management of Osteoporosis: Prevention, Diagnosis and TreatmentView all 12 articles
Association of baseline osteocalcin and femoral neck bone mineral density in healthy women with future risk of fractures, cardiovascular disease, diabetes and death (FCDD)
Provisionally accepted
Zheng-Can PanYu-Ying YangXiao-Jing Chen
Tao JiangJia-Xi SongChun-Xiang ShengYi-Zhu Wang
Min XuYan-Hua DengGuang-Ping YuLi-Hao Sun
Hong Yan Zhao
Jian-min Liu
Bei Tao*- Ruijin Hospital North, Shanghai, China
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Purpose This study aimed to explore relationships between baseline bone metabolism markers and long-term outcomes, collectively referred to as fractures, cardiovascular diseases, diabetes and all-cause death (FCDD), in healthy women at baseline and identify predictive markers for outcome. Methods This study included 356 healthy women and assessed baseline bone turnover markers—osteocalcin, C-telopeptide of type I collagen—as well as bone mineral densities (BMDs) at lumbar spine (L1-4), femoral neck (FN) and total hip (TH). A 16-year retrospective follow-up via telephone questionnaire tracked FCDD occurrence. Statistical tests, including univariate analysis, forward stepwise regression and logistic regression analysis, were used to determine correlations between baseline markers and FCDD. Results Among 356 participants, 291 (81.7%) completed follow-up; 109 (37.5%) experienced FCDD. 47 participants experienced fractures (16.2%), 27 developed diabetes (9.3%), 25 experienced cardiovascular events or mortality (8.6%). Stepwise regression identified osteocalcin (odds ratio: 0.938, 95% confidence interval: 0.895–0.980, P=0.006) and FN BMD (odds ratio: 0.066, 95% confidence interval: 0.008– 0.490, P=0.009) as independent predictors. However, logistic regression revealed that the protective effect of FN BMD was attenuated after adjusting for age, body mass index, years since menopause, whereas osteocalcin remained significant (P<0.05). Heatmap visualization revealed the lowest FCDD risk among both markers in the highest tertiles (P=0.002) Conclusion Our study shows that baseline osteocalcin independently associated with long-term FCDD outcomes in healthy women. These insights offer valuable guidance for the development of personalized health prevention and intervention strategies.
Keywords: bone metabolism, diabetes, fractures, cardiovascular disease, Mortality
Received: 24 Jun 2025; Accepted: 03 Nov 2025.
Copyright: © 2025 Pan, Yang, Chen, Jiang, Song, Sheng, Wang, Xu, Deng, Yu, Sun, Zhao, Liu and Tao. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Bei Tao, taobei1981@hotmail.com
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