Soluble Tumor Necrosis Factor Alpha Receptor 1, Bone Resorption, and Bone Mineral Density in the Year Following Hip Fractures: The Baltimore Hip Studies

Shabnam Salimi, Michelle Shardell, Ram Miller, Ann L. Gruber-Baldini, Denise Orwig, Neal Fedarko, Marc C. Hochberg, Jack M. Guralnik, Jay Magaziner

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Although inflammation is known to influence bone turnover and bone mineral density (BMD), less is known about role of soluble tumor necrosis factor alpha receptor 1 (sTNFα-R1) in changes in bone turnover and BMD in the year after hip fracture. We studied 245 persons (117 men and 128 women) from the Baltimore Hip Studies. Bone turnover markers of resorption (carboxy-terminal type I collagen cross-links [CTX-I]) and formation (amino-terminal propeptide type I collagen [P1NP]), BMD of the contralateral hip, and sTNFα-R1 were measured within 15 days of hospitalization and 2, 6, and 12 months later. Latent class growth modeling was used to determine sTNFα-R1 trajectories. Weighted generalized estimating equations were used to examine the association of sTNFα-R1 trajectories with serum levels of CTX-I and P1NP and BMD; standardized beta coefficients ((Formula presented.)) are reported. Higher baseline sTNFα-R1 was significantly associated with a greater rate of CTX-I change ((Formula presented.) = 0.26, p = 0.004). Four distinct sTNFα-R1 trajectories were identified. The two groups with higher sTNFα-R1 levels during the year following fracture had faster increasing levels of CTX-I compared to the group with lowest sTNFα-R1 levels (men: group 3: (Formula presented.) = 0.76, p = 0.02; group 4: (Formula presented.) = 1.4, p < 0.001; women: group 3; (Formula presented.) = 0.67, p = 0.02; group 4: (Formula presented.) = 1.3, p = 0.004). Men in the highest sTNFα-R1 group had a greater decline in BMD compared to the lowest sTNFα-R1 group (2-month (Formula presented.) = –0.01, p = 0.01; 6-month: (Formula presented.) = –0.09, p = 0.001; 12-months: (Formula presented.) = –0.1, p < 0.001). An increasing rate of CTX-I was associated with a steeper decline in total hip BMD in those within higher sTNFα-R1 trajectory groups (p < 0.001). CTX-I was significantly increased with sTNFα-R1 in both sexes. CTX-I and the highest sTNFα-R1 trajectory were significantly associated with declines in total hip BMD in men. Interventions that reduce systemic inflammation should be explored to reduce bone resorption and prevent a decline in BMD after hip fracture.

Original languageEnglish (US)
Pages (from-to)1649-1656
Number of pages8
JournalJournal of Bone and Mineral Research
Issue number9
StatePublished - Sep 2018



ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Orthopedics and Sports Medicine


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