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16.03.2016 | Original Article | Ausgabe 8/2016

Osteoporosis International 8/2016

The circulating sphingosine-1-phosphate level predicts incident fracture in postmenopausal women: a 3.5-year follow-up observation study

Osteoporosis International > Ausgabe 8/2016
S. J. Bae, S. H. Lee, S. H. Ahn, H.-M. Kim, B.-J. Kim, J.-M. Koh
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1007/​s00198-016-3565-z) contains supplementary material, which is available to authorized users.
S. J. Bae and S. H. Lee contributed equally to this work.



A high level of circulating sphingosine-1-phosphate (S1P) is associated with a high incidence of osteoporotic fracture and a high rate of an insufficient response to bisphosphonate therapy.


Sphingosine-1-phosphate (S1P) is a significant regulator of bone metabolism. Recently, we found that a high plasma S1P level is associated with low bone mineral density (BMD), high levels of bone resorption markers (BRMs), and a high risk of prevalent vertebral fracture in postmenopausal women. We investigated the possibility that S1P is a predictor of incident fracture.


A total of 248 postmenopausal women participated in this longitudinal study and were followed up for a mean duration of 3.5 years (untreated [n = 76] or treated with bisphosphonate or hormone replacement therapy [n = 172]). The baseline plasma S1P level and prevalent and incident fracture occurrence were assessed.


A high S1P level was significantly associated with a higher rate of prevalent fracture after adjusting for femoral neck (FN) BMD, BRM, and potential confounders (odds ratio = 2.05; 95 % confidence interval [CI] = 1.03–4.00). Incident fractures occurred more frequently in the highest S1P tertile (T3) than in the lower two tertiles (T1–2) after adjusting for confounders, including baseline FN BMD, prevalent fracture, antiosteoporotic medication, annualized changes in FN BMD, BRM, and potential confounders (hazard ratio = 5.52; 95 % CI = 1.04–56.54). Insufficient response to bisphosphonate therapy occurred more frequently in T3 than T1–2 (odds ratio = 4.43; 95 % CI = 1.02–21.25).


The plasma S1P level may be a potential predictor of fracture occurrence and an insufficient response to bisphosphonate therapy in postmenopausal women.

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