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Background Over 90% of the Pakistani population being vitamin D deficient contributes tremendously to annually increasing trend of osteoporosis worldwide. Fetuin-A is one of the bone turnover markers which play a dynamic role in improving bone health. Similarly, serum beta Crosslaps (CTx) is a sensitive marker of bone resorption. This study aimed to correlate serum levels of fetuin-A and CTx with bone health in healthy females. Methods Total of 115 females of ages between 20 to 60 years were recruited in this cross-sectional study from Jinnah Postgraduate Medical Centre, Karachi. They were grouped as A & B on the basis of Bone Mass Density (BMD) T score > -1 and < -1, respectively. Anthropometric measurements were recorded and BMD was calculated by ultrasound bone densitometer (considering T-score ≥ -1 as normal). Serum was analyzed for bone minerals, vitamin D, CTX and fetuin-A. Data was analyzed statistically by SPSS 21, Mann-Whitney U test and Spearman’s correlation (r) were applied where p value < 0.05 was considered significant. Results The complete cohort showed normal calcium levels while a low level of vitamin D was observed (P > 0.05). Interestingly, both serum fetuin-A and CTx levels were found high in group B as compared to group A (p < 0.001). Serum fetuin (r = -0.718, p < 0.001) and CTx (r = -0.756, p < 0.001) depicted negative correlation with BMD % and BMI, while their levels were positively associated to each other (r = 0.481, p < 0.001). Discussion Low values of BMD T-score (less than -1) are associated with high levels of fetuin-A in our female population. Raised fetuin-A in the presence of low vitamin D and high CTx, suggests that serum fetuin-A does not reflect increased bone turnover. Further experiments are required to validate the role of fetuin-A in bone mineralization.

Reciprocal Relation of Fetuin-A and Beta Crosslaps with Bone Health