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BMD underestimates fracture risk in T2D, but the predictive role of bone turnover markers (BTMs) on fracture risk in T2D has not been explored. Thus, we sought to determine whether BTMs predict incident fractures in subjects with T2D. For this case-cohort study, we used data from the Health, Aging, and Body Composition (Health ABC) Study of well-functioning older adults, aged 70 to 79\u2009years at baseline (April 1997\u2013June 1998). The case-cohort sample consisted of (i) the cases, composed of all 223 participants who experienced incident fractures of the hip, clinical spine, or distal forearm within the first 9\u2009years of study follow-up; and (ii) the subcohort of 508 randomly sampled participants from three strata at baseline (T2D, prediabetes, and normoglycemia) from the entire Health ABC cohort. A total of 690 subjects (223 cases, of whom 41 were in the subcohort) were included in analyses. BTMs (C-terminal telopeptide of type I collagen [CTX], osteocalcin [OC], and procollagen type 1 N-terminal propeptide [P1NP]) were measured in archived baseline serum. Cox regression with robust variance estimation was used to estimate the adjusted hazard ratio (HR) for fracture per 20% increase in BTMs. In nondiabetes (prediabetes plus normoglycemia), fracture risk was increased with higher CTX (HR 1.10; 95% confidence interval [CI], 1.01 to 1.20 for each 20% increase in CTX). Risk was not increased in T2D (HR 0.92; 95% CI, 0.81 to 1.04; p for interaction .045). Similarly, both OC and P1NP were associated with higher risk of fracture in nondiabetes, but not in T2D, with p for interaction of .078 and .109, respectively. In conclusion, BTMs did not predict incident fracture risk in T2D but were modestly associated with fracture risk in nondiabetes. \u00a9 2020 American Society for Bone and Mineral Research.<\/jats:p>","DOI":"10.1002\/jbmr.4140","type":"journal-article","created":{"date-parts":[[2020,7,27]],"date-time":"2020-07-27T14:14:08Z","timestamp":1595859248000},"page":"2363-2371","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":46,"title":["Bone Turnover Markers Do Not Predict Fracture Risk in Type 2 Diabetes"],"prefix":"10.1093","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3091-8205","authenticated-orcid":false,"given":"Nicola","family":"Napoli","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Division of Bone and Mineral Diseases, Musculoskeletal Research Center Washington University School of Medicine St. Louis MO USA"},{"name":"Division of Endocrinology and Diabetes University Campus Bio-Medico di Roma Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7066-5292","authenticated-orcid":false,"given":"Caterina","family":"Conte","sequence":"additional","affiliation":[{"name":"Department of Human Sciences and Promotion of the Quality of Life San Raffaele Open University Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Eastell","sequence":"additional","affiliation":[{"name":"Metabolic Bone Centre Northern General Hospital Sheffield UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan K","family":"Ewing","sequence":"additional","affiliation":[{"name":"Department Epidemiology and Biostatistics University of California, San Francisco San Francisco CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5261-7721","authenticated-orcid":false,"given":"Douglas C","family":"Bauer","sequence":"additional","affiliation":[{"name":"Departments of Medicine and Epidemiology and Biostatistics University of California, San Francisco San Francisco CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elsa S","family":"Strotmeyer","sequence":"additional","affiliation":[{"name":"Center for Aging and Population Health, Department of Epidemiology, Graduate School of Public Health University of Pittsburgh Pittsburgh PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5318-7575","authenticated-orcid":false,"given":"Dennis M","family":"Black","sequence":"additional","affiliation":[{"name":"Departments of Medicine and Epidemiology and Biostatistics University of California, San Francisco San Francisco CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1086-1560","authenticated-orcid":false,"given":"Elizabeth 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