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Levels of Bone Formation Marker P1np in Individuals Over 50 Years: A Systematic Review and Meta-Analysis Publisher



Hesari E ; Hajivalizadeh S ; Mansourzadeh MJ ; Khalagi K ; Fahimfar N ; Sanjari M ; Cheraghi Z ; Gharibzadeh S ; Tanha K ; Khashayar P ; Yarmohammadi H ; Naderpour S ; Mehri A ; Noorali S Show All Authors
Authors
  1. Hesari E
  2. Hajivalizadeh S
  3. Mansourzadeh MJ
  4. Khalagi K
  5. Fahimfar N
  6. Sanjari M
  7. Cheraghi Z
  8. Gharibzadeh S
  9. Tanha K
  10. Khashayar P
  11. Yarmohammadi H
  12. Naderpour S
  13. Mehri A
  14. Noorali S
  15. Fatahi A
  16. Mounesan L
  17. Akbarzadeh I
  18. Tajrishi FZ
  19. Varse F
  20. Ghazbani A
  21. Razi F
  22. Larijani B
  23. Ostovar A

Source: Journal of Diabetes and Metabolic Disorders Published:2026


Abstract

Background: Procollagen type 1 N-terminal propeptide (P1NP) is a vital biomarker for evaluating bone formation, reflecting osteoblast activity and offering meaningful insights into bone health. Elevated P1NP levels may signal heightened bone turnover, as observed in conditions like osteoporosis. Conversely, decreased P1NP levels could serve as a prognostic indicator for fracture risk stratification in the elderly population. Objectives: This study aimed to establish P1NP levels to enhance diagnostic and therapeutic methods in evaluating bone health. Methods: A systematic literature search were performed across multiple databases until April 15, 2023, focusing on articles that measured serum P1NP levels in healthy individuals aged 50 and older. After removing duplicates, two reviewers evaluated titles and abstracts of potentially relevant studies. Data were extracted on authors, publication year, sample size, laboratory kits used, participants’ fasting status, sex, and serum P1NP levels using a pre-designed data sheet. The risk of bias was assessed with the Newcastle Ottawa checklist, and pooled mean P1NP levels were estimated using Stata software, with statistical heterogeneity analysed through Cochran’s Q test and the I2 statistic. Results: Out of 11,011 studies identified, 49 met the inclusion criteria after screening and removing 4,227 duplicates. The pooled P1NP levels were 39.6 ng/mL for males and 48.5 ng/mL for females, with a combined level of 46.5 ng/mL. Under fasting conditions, P1NP levels were 40.0 ng/mL for males and 49.7 ng/mL for females. Funnel plot analysis suggested publication bias, but the overall quality of the studies was assessed as generally strong. Conclusion: The current study points out the necessity for the determination of sex-specific values for P1NP, highlighting elevated P1NP levels in women to be associated with a higher risk of osteoporosis. © The Author(s), under exclusive licence to Tehran University of Medical Sciences 2026.