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Whether other bone turnover markers (BTMs) are associated with mortality risk differently from ucOC also remains uncertain. Our aim was to determine associations of serum ucOC with all-cause and cause-specific mortality and compare these with the corresponding associations of serum total osteocalcin (TOC), procollagen type I N-propeptide (PINP), and collagen type 1 C-terminal cross-linked telopeptide (CTX) in older men. We conducted a prospective cohort study of 3871 community-dwelling men, aged 77.0\u2009\u00b1\u20093.6\u2009years at baseline, followed for a median of 12.3\u2009years. Exposure variables were ucOC, TOC, PINP, and CTX concentrations assayed in serum. Outcomes were incidence of all deaths and deaths due to cardiovascular disease (CVD) or cancer, ascertained using death registry data. Cox regression analyses adjusted for cardiovascular risk factors and prevalent CVD and for prevalent cancer in analyses of cancer-related mortality. Higher concentrations of ucOC, PINP, and CTX were associated with all-cause mortality (hazard ratio [HR] per 1 standard deviation increase: ucOC 1.12, 95% confidence interval [CI] 1.06\u20131.18, p\u2009&amp;lt;\u20090.001; PINP HR\u00a0=\u00a01.06, 95% CI 1.01\u20131.11, p\u00a0=\u00a00.009; CTX HR\u00a0=\u00a01.13, 95% CI 1.08\u20131.19, p\u2009&amp;lt;\u20090.001), but TOC was not associated. Similar results were found after excluding men with an incident fracture during follow-up. Higher ucOC and CTX were associated with CVD mortality (ucOC HR per 1 SD increase 1.13, 95% CI 1.05\u20131.22, p\u00a0=\u00a00.001; CTX HR\u00a0=\u00a01.12, 95% CI 1.04\u20131.20, p\u00a0=\u00a00.003), but this result was not significant in competing risks analysis. Higher CTX was also associated with cancer mortality (HR\u00a0=\u00a01.12, 95% CI 1.01\u20131.23, p\u00a0=\u00a00.024). In conclusion, in older men, higher bone turnover, assessed by BTMs including ucOC, is a biomarker for all-cause mortality risk. Undercarboxylated osteocalcin was a more informative biomarker for this outcome than TOC. Higher CTX was associated with all-cause and cancer-related mortality. Further evaluation of causality and potential underlying mechanisms is warranted. \u00a9 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).<\/jats:p>","DOI":"10.1002\/jbmr.4631","type":"journal-article","created":{"date-parts":[[2022,6,11]],"date-time":"2022-06-11T08:15:29Z","timestamp":1654935329000},"page":"1464-1472","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Bone Turnover Markers Including Undercarboxylated Osteocalcin Are Associated With Mortality Risk in Older Men"],"prefix":"10.1093","volume":"37","author":[{"given":"Courtney L","family":"Robertson","sequence":"first","affiliation":[{"name":"Medical School University of Western Australia Perth Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gaurav","family":"Ghosh","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Diabetes Fiona Stanley Hospital Perth Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick","family":"Fitzgerald","sequence":"additional","affiliation":[{"name":"Western Australian Centre for Healthy Ageing University of Western Australia Perth Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Graeme J","family":"Hankey","sequence":"additional","affiliation":[{"name":"Medical School University of Western Australia Perth Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9194-2033","authenticated-orcid":false,"given":"Itamar","family":"Levinger","sequence":"additional","affiliation":[{"name":"Australian Institute for Musculoskeletal Science, University of Melbourne and Western Health St Albans Australia"},{"name":"Institute for Health and Sport, Victoria University Melbourne Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan","family":"Golledge","sequence":"additional","affiliation":[{"name":"Department of Vascular and Endovascular Surgery Townsville University Hospital Townsville Australia"},{"name":"Queensland Research Centre for Peripheral Vascular Disease James Cook University Townsville Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Osvaldo P","family":"Almeida","sequence":"additional","affiliation":[{"name":"Western Australian Centre for Healthy Ageing University of Western Australia Perth Australia"},{"name":"Medical School University of Western Australia Perth Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leon","family":"Flicker","sequence":"additional","affiliation":[{"name":"Western Australian Centre for Healthy Ageing University of Western Australia Perth Australia"},{"name":"Medical School University of Western Australia Perth Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter R","family":"Ebeling","sequence":"additional","affiliation":[{"name":"Department of Medicine School of Clinical Sciences, Monash University Clayton Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7612-5892","authenticated-orcid":false,"given":"Bu B","family":"Yeap","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Diabetes Fiona Stanley Hospital Perth Australia"},{"name":"Medical School University of Western Australia Perth Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2022,6,11]]},"reference":[{"key":"2024012713552015500_jbmr4631-bib-0001","doi-asserted-by":"crossref","first-page":"456","DOI":"10.1016\/j.cell.2007.05.047","article-title":"Endocrine regulation of energy metabolism by the 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