Association between Serum Osteocalcin Levels and Metabolic Syndrome according to the Menopausal Status of Korean Women

Background: Osteocalcin is known to regulate energy metabolism. Recently, metabolic syndrome (MetS) has been found to be associated with reduced levels of osteocalcin in men, as well as in postmenopausal women. The aim of this study was to investigate the association between serum osteocalcin and MetS in premenopausal women, compared with that in postmenopausal women. Methods: This cross-sectional study was based on 5,896 participants who completed a health screening examination. They were classified according to their menopausal status. Each group was subdivided into non-MetS and MetS groups according to the modified National Cholesterol Education Program-Adult Treatment Panel III criteria. Serum osteocalcin levels were measured using the electrochemiluminescence immunoassay. Results: Serum osteocalcin level was significantly lower in women with MetS than in those without MetS, after adjusting for confounders (14.12 +/- 0.04 vs. 13.17 +/- 0.13 [P= 0.004] in premenopausal women, and 20.34 +/- 0.09 vs. 19.62 +/- 0.21 [P < 0.001] in postmenopausal women), regardless of their menopausal status. Serum osteocalcin levels decreased correspondingly with an increasing number of MetS elements (Pfor trend < 0.001). Multiple regression analysis demonstrated that waist circumference (beta= -0.085 [P < 0.001] and beta = -0.137 [P< 0.001)) and hemoglobin A1c (beta = -0.09 [P < 0.001] and beta = -0.145 [11 < 0.001]) were independent predictors of osteocalcin in premenopausal and postmenopausal women. Triglyceride levels were also independently associated with osteocalcin levels in premenopausal women (1.3 = -0.004 [P< 0.013]). The odds ratio (OR) for MetS was significantly higher in the lowest quartile than in the highest quartile of serum osteocalcin levels after adjusting forage, alkaline phosphatase, uric acid, high sensitivity C-reactive protein, and body mass index in all women (OR, 2.00; 95% confidence interval (CI], 1.49-2.68) as well as in premenopausal (OR, 2.23; 95% CI, 1.39-3.58) and postmenopausal (OR, 2.01; 95% CI, 1.26-3.23) subgroups. Conclusion: Lower serum osteocalcin concentrations were significantly associated with MetS in both premenopausal and postmenopausal women and were therefore independent of menopausal status.