• ALAA SALAM MOHAMED Biochemistry Department, Faculty of Pharmacy (Girls), Al-Azhar University, Cairo, Egypt
  • ASHRAF ISMAIL KHALIFA Rheumatology and Rehabilitation Department, Faculty of Medicine (Boys), Al-Azhar University, Cairo, Egypt
  • ASHRAF ABDEL-MONEAM ABOTALEB Clinical Pathology Department (Boys), Al-Azhar University, Cairo, Egypt
  • NOHA ABDEL-RAHMAN ELDESOKY Biochemistry Department, Faculty of Pharmacy (Girls), Al-Azhar University, Cairo, Egypt


Objective: This study aimed to compare between periostin and osteocalcin as biomarkers in Egyptian postmenopausal women with osteoporosis and to explore their possible relationship with fracture risk.

Methods: This study included 90 postmenopausal females recruited from Al-Hussein University Hospital, Cairo, Egypt; divided into three groups; 35 postmenopausal osteoporotic females with low fracture risk (group I), 35 postmenopausal osteoporotic females with high fracture risk (group II), and 20 apparently healthy controls. Serum periostin, osteocalcin, and estrogen were measured by Enzyme Linked Immunosorbent Assay (ELISA). Fracture risk assessment was calculated. Alkaline phosphatase (ALP), total and ionized calcium, Aspartate transaminase (AST), and Alanine transaminase (ALT) were measured spectrophotometrically.

Results: The diagnostic performance of periostin for discriminating high fracture risk from low fracture risk groups showed the specificity of (68.6 %) and sensitivity of (100 %), while for osteocalcin the specificity was (51.4 %) and the sensitivity was (68.6 %) respectively. Moreover, the multi Receiver Operating Characteristics (multi-ROC) curve for periostin and osteocalcin together revealed improved specificity and sensitivity of (100 %) each.

Conclusion: Periostin was superior to osteocalcin in discriminating high fracture risk from low fracture risk postmenopausal osteoporotic groups. Moreover, dual use of both markers gave the highest discriminative power between low and high fracture risk groups with 100 % specificity and sensitivity.

Keywords: Postmenopausal osteoporosis, Periostin, Osteocalcin, Estrogen, DXA, Fracture risk


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Author Biographies

ALAA SALAM MOHAMED, Biochemistry Department, Faculty of Pharmacy (Girls), Al-Azhar University, Cairo, Egypt









ASHRAF ISMAIL KHALIFA, Rheumatology and Rehabilitation Department, Faculty of Medicine (Boys), Al-Azhar University, Cairo, Egypt




ASHRAF ABDEL-MONEAM ABOTALEB, Clinical Pathology Department (Boys), Al-Azhar University, Cairo, Egypt





NOHA ABDEL-RAHMAN ELDESOKY, Biochemistry Department, Faculty of Pharmacy (Girls), Al-Azhar University, Cairo, Egypt






1. Hutomo DI, Masulili SLC, Tadjoedin FM, Kusdhany LS. Correlation of serum osteocalcin level and periodontal attachment loss with osteoporosis risk status in postmenopausal women. Int J Appl Pharm 2018;9:92-4.
2. Jawhar DS, Hassan NA, Shamssain MH. Dual-energy x-ray absorptiometry scan (DXA) findings in diabetic and non-diabetic female: a retrospective cohort study. Med J Malaysia 2020; 75:47 –51.
3. Gunna SH, Yadav S. Low bone mass and its correlation in systemic sclerosis. Indian J Rheumatol 2019;14:100–1.
4. Diez Perez A, Brandi ML, Al-Daghri N, Branco JC, Bruyere O, Cavalli L, et al. Radiofrequency echographic multi-spectrometry for the in vivo assessment of bone strength: state of the art-outcomes of an expert consensus meeting organized by the European society for clinical and economic aspects of osteoporosis, osteoarthritis and musculoskeletal diseases (ESCEO). Aging Clin Exp Res 2019;31:1375–89.
5. Marushchak ?, Krynytska I. Pharmacological treatment of osteoporosis in patients with coronary heart disease complicated plicated by chronic heart failure. Asian J Pharm Clin Res 2019;12:443-6.
6. Jain RK, Vokes T. Dual-energy X-ray absorptiometry. J Clin Densitom 2017;20:291–303.
7. Krugh M, Langaker MD. Dual-energy X-ray absorptiometry (DEXA). In: Stat pearls. Available from: https:// [Last accessed on 24 Apr 2020].
8. Brichacek AL, Brown CM. Alkaline phosphatase: a potential biomarker for stroke and implications for treatment. Metab Brain Dis 2019;34:3–19.
9. Abreu C, Dionisio MR, Silva JC, Costa L. Cancer treatment-induced bone loss (CTIBL). In: Huhtaniemi I, Martini L. (editors). Encyclopedia of endocrine diseases. 2nd ed. United States: San Diego; 2018. p. 296–303.
10. Bhattoa HP. Laboratory aspects and clinical utility of bone turnover markers. EJIFCC 2018;29:117–28.
11. Rowe P, Koller A, Sharma S. Physiology, bone remodeling. Stat Pearls. Available from: books/NBK499863/. [Last accessed on 29 Mar 2020].
12. Diaz Franco MC, De Leon RFD, Villafan Bernal JR. Osteocalcin GPRC6A: an update of its clinical and biological multi organic interactions (review). Mol Med Rep 2019;19:15–22.
13. Macias I, Alcorta Sevillano N, Rodriguez CI, Rodriguez CI, Arantza Infante A. Osteoporosis and the potential of cell-based therapeutic strategies. Int J Mol Sci 2020;21:1653.
14. Carvalho MS, Poundarik AA, Cabral JMS, da Silva CL, Vashishth D. Biomimetic matrices for rapidly forming mineralized bone tissue based on stem cell-mediated osteogenesis. Sci Rep 2018;8:14388.
15. Gonzalez Gonzalez L, Alonso J. Periostin: a matricellular protein with multiple functions in cancer development and progression. Front Oncol 2018;8:225.
16. Varughese R, Semprini R, Munro C, Fingleton J, Holweg C, Weatherall M, et al. Serum periostin levels following small bone fractures, long bone fractures and joint replacements: an observational study. Allergy Asthma Clin Immunol 2018;14:30.
17. Li C, Li X, Wang X, Miao P, Liu J, Li C, et al. Periostin mediates estrogen-induced osteogenic differentiation of bone marrow stromal cells in ovariectomized rats. BioMed Res Int 2020:1–10.
18. Garnero P, Cremers S. Chapter 78-bone turnover markers. In: Bilezikian JP, Martin TJ, ? Clemens TL. et al. editors. Principles of Bone Biology. 4th ed. London: Academic Press; 2019. p. 1801–39.
19. Camacho PM, Petak SM, Binkley N, Clarke BL, Harris ST, Hurley DL, et al. AACE/ACE clinical practice guidelines. American association of clinical endocrinologists. Clinical guidelines for the diagnosis and treatment of postmenopausal osteoporosis. Endocr Pract 2016;22:S1–42.
20. Tu KN, Lie JD, Wan CKV, Cameron M, Austel AG, Nguyen JK, et al. Osteoporosis: A review of treatment options. P T J 2018;43:92–104.
21. Porter JL, Varacallo M. Osteoporosis. stat pearls. Available from: [Last accessed on 15 Mar 2020].
22. Tian L, Yang R, Wei L, Liu J, Yang Y, Shao F, et al. Prevalence of osteoporosis and related lifestyle and metabolic factors of postmenopausal women and elderly men: a cross-sectional study in Gansu province, Northwestern of China. Medicine (Baltimore) 2017;96:e8294.
23. Qu XL, Zheng B, Chen TY, Cao ZR, Qu B, Jiang T. Bone turnover markers and bone mineral density to predict osteoporotic fractures in older women: a retrospective comparative study. Orthopaedic Surgery 2020;12:116–23.
24. Tomasevic TS, Vazic A, Issaka A, Hanna F. Comparative assessment of fracture risk among osteoporosis and osteopenia patients: a cross-sectional study. Open Access Rheumatol 2018;10:61–6.
25. Alam MF, Rana MA, Alam MS. Osteocalcin, a promising marker of osteoporosis: evaluation in postmenopausal females with osteoporosis. Int Adv Med 2019;6:xxx–x.
26. Beg M, Akhtar N, Alam MF. Vitamin D status and serum osteocalcin levels in post-menopausal osteoporosis: effect of bisphosphonate therapy. JIACM 2014;15:172–6.
27. Singh S, Kumar D, Lal AK. Serum osteocalcin as a diagnostic biomarker for primary osteoporosis in women. J Clin Diagn Res 2015;9:RC04–7.
28. Soroosh M, Khabbazi A, Mahdavi AM. Serum osteocalcin levels in postmenopausal osteoporotic women receiving alendronate. Rheumatol Res 2018;3:83-9.
29. Rai M, Rai T, Rai S, Parinita K. Serum osteocalcin: a potential biomarker for primary osteoporosis. Int J Clin Biochem Res 2018;5:392–6.
30. Liu Z, Chen R, Jiang Y, Yang Y, He L, Luo C, et al. A meta-analysis of serum osteocalcin level in postmenopausal osteoporotic women compared to controls. BMC Musculoskeletal Disord 2019;20:532.
31. Dai Z, Wang R, Ang LW, Yuan JM, Koh WP. Bone turnover biomarkers and risk of osteoporotic hip fracture in an Asian population. Bone 2016;83:171–7.
32. Bonnet N, Biver E, Chevalley T, Rizzoli R, Garnero P, Ferrari S. Serum levels of a cathepsin?K generated periostin fragment predict incident low?trauma fractures in postmenopausal women independently of BMD and FRAX. JBMR 2017;32:2232–8.
33. Kim BJ, Rhee Y, Kim CH, Baek KH, Min YK, Kim DY. Plasma periostin associates significantly with non-vertebral but not vertebral fractures in postmenopausal women: clinical evidence for the different effects of periostin depending on the skeletal site. Bone 2015;81:435–41.
34. Sakellariou GT, Anastasilakis AD, Bisbinas I, Oikonomou D, Gerou S, Polyzos SA. Circulating periostin levels in patients with AS: association with clinical and radiographic variables, inflammatory markers and molecules involved in bone formation. Rheumatology (Oxford) 2015;54:908–14.
35. Kim BJ, Lee SH, Koh JM. Potential biomarkers to improve the prediction of osteoporotic fractures. Endocrinol Metab (Seoul) 2020;35:55–63.
36. De Lageneste OD, Julien A, Abou-Khalil R, Frangi G, Carvalho C, Cagnard N, et al. Periostium contains skeletal stem cells with high bone regenerative potential controlled by periostin. Nat Commun 2018;9:773.
37. Zhang M, Ishikawa S, Inagawa TN, Ikemoto H, Guo S, Mand S, et al. Influence of mechanical force on bone matrix proteins in ovariectomized mice and osteoblast-like MC3T3-E1 cells. In Vivo 2017;31:87–95.
38. Kudo A. Periostin in bone biology. In: Kudo A. editor. Periostin. Advances in Experimental Medicine and Biology. 1st ed. Singapore: Springer; 2019. p. 43–7.
39. Yan J, Liu HJ, Li H, Chen L, Bian YQ, Zhao B, et al. Circulating periostin levels increase in association with bone density loss and healing progression during the early phase of hip fracture in Chinese older women. Osteoporos 2017;28:2335–41.
40. Luo J, Deng W. Serum periostin level is not a predictor of early-stage bone loss in Chinese postmenopausal women. Clin Lab 2019;65. DOI:10.7754/clin.lab.2019.190329
41. Walsh JS, Gossiel F, Scott JR. Effect of age and gender on serum periostin: relationship to cortical measures, bone turnover and hormones. Bone 2017;99:8–13.
42. Gossiel F, Scott JR, Paggiosi MA, Naylor KE, Closkey EV, Peel NF, et al. The effect of teriparatide treatment on circulating periostin and its relationship to regulators of bone formation and BMD in postmenopausal women with osteoporosis. J Clin Endocrinol Metab 2018;103:1302–9.
43. Terpos E, Ntanasis Stathopoulos I, Gavriatopoulou M, Dimopoulos MA. Pathogenesis of bone disease in multiple myeloma: from bench to bedside. Blood Cancer J 2018;98:1–7.
44. Rousseau JC, Sornay Rendu E, Bertholon C, Chapurlat R, Garnero P. Serum periostin is associated with fracture risk in postmenopausal women: a 7-year prospective analysis of the OFELY study. J Clin Endocrinol Metab 2014;99:2533–9.
45. Anastasilakis AD, Polyzos SA, Makras P, Savvides M, Sakellariou GT, Gkiomisi A, et al. Circulating periostin levels do not differ between postmenopausal women with normal and low bone mass and are not affected by zoledronic acid treatment. Horm Metab Res 2014;46:145–9.
46. Hu F, Shang XF, Wang W, Jiang W, Fang C, Tan D, et al. High-level expression of periostin is significantly correlated with tumor angiogenesis and poor prognosis in osteosarcoma. Int J Exp Pathol 2016;97:86–92.
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How to Cite
MOHAMED, A. S., A. I. KHALIFA, A. A.-M. ABOTALEB, and N. A.-R. ELDESOKY. “COMPARATIVE STUDY BETWEEN PERIOSTIN AND OSTEOCALCIN AS BIOMARKERS FOR OSTEOPOROSIS AND FRACTURE RISK IN EGYPTIAN POSTMENOPAUSAL WOMEN”. International Journal of Pharmacy and Pharmaceutical Sciences, Vol. 12, no. 9, July 2020, pp. 17-22, doi:10.22159/ijpps.2020v12i9.38713.
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