Urinary N-telopeptide levels discriminate normal, osteopenic, and osteoporotic bone mineral density

Schneider, Donald L.

doi:10.1001/archinte.157.11.1241

Cited by 48 publications

(33 citation statements)

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“…These markers have been extensively used for both the assessment of therapeutic efficacy of antiresorptive drugs in osteoporosis and for prediction of fracture risk in postmenopausal women [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. We measured urinary and serum CTx and urinary NTx in a large cohort of untreated, healthy women stratified on the basis of their menopausal status and BMD.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, biochemical markers of bone turnover provide a rapid assessment of the effects of antiresorptive therapies such as hormone replacement therapy, bisphosphonates, and calcitonin which induce a decrease in the levels of bone markers that is correlated with the long-term effect of such treatments on bone mass [5][6][7][8][9][10][11][12][13][14][15]. Due to the small annual changes in BMD, the effect of antiresorptive therapy can only be reliably monitored by BMD measurement after several years followup [5,10,13].Bone markers might also be used to prognose a high rate of bone less in postmenopausal women who would subsequently develop osteoporosis and fractures [16][17][18][19][20][21][22][23][24][25]. Bone turnover increases after menopause and remains elevated in late postmenopausal women.…”

mentioning

confidence: 99%

“…Bone markers might also be used to prognose a high rate of bone less in postmenopausal women who would subsequently develop osteoporosis and fractures [16][17][18][19][20][21][22][23][24][25]. Bone turnover increases after menopause and remains elevated in late postmenopausal women.…”

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confidence: 99%

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Bone Resorption in Post-menopausal Women with Normal and Low BMD Assessed with Biochemical Markers Specific for Telopeptide Derived Degradation Products of Collagen Type I

Reginster¹,

Henrotin

Christiansen

et al. 2001

Calcif Tissue Int

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Abstract. Biochemical markers of bone resorption can be used clinically to predict the risk of osteoporosis-related fractures (prognostic tool) and to assess the response of an osteoporotic patient to an antiresorptive therapy (monitoring tool). Our aim was to assess the ability of four currently marketed biochemical markers of bone resorption, based on the measurement of degradation products from collage type I telopeptides to monitor the elevated resorption associated with menopause. Women (846) were stratified for menopause, age, and bone mineral density and the following markers were measured: urinary cross-linked Ntelopeptides of type I collagen (NTx), the levels of breakdown products of type I collagen C-telopeptides in serum (S-CTx), and in urine, by ELISA (U-CTx-E), and RIA (UCTx-R). Furthermore, the ratio (␣/␤) between the ␣L form of CTx measured in the CTx RIA and the ␤L form measured in the ELISA was calculated. The mean difference was calculated for each marker in women with osteopenia (Op) or osteoporosis (PMO) (WHO definition) compared with healthy premenopausal (Pre) women and postmenopausal (N Post) women with normal bone mass. Serum CTx showed the highest elevation in post-compared with premenopausal women. All marker values were significantly higher in Op and PMO subjects compared with both Pre and to N Post women. Compared with premenopausal values, the largest elevation in both Op and PMO women was observed for serum CTx. Compared with N Post, urine NTx showed the highest increase in OP subjects. The ␣/␤ CTx ratio was elevated in post-compared with Pre women, but there was no difference in the ratio among N Post, Op, or PMO women. In conclusion, postmenopausal women showed elevated turnover with all bone resorption markers, but with substantial individual variation in resorption levels. Furthermore, the turnover process in postmenopausal women appears to be quantitatively different from the premenopausal stage, apparent as altered ␣/␤ CTx ratios. Key words: Osteoporosis -Biochemical markers -Bone turnover -Collagen type I -Antiresorptive therapiesDiagnosis.Assessment of bone physiology has been greatly improved by the development of specific and sensitive markers of bone remodeling [1,2]. Biochemical markers have advantages because they are noninvasive, inexpensive, reflect turnover in the whole skeleton, and allow repeated evaluation [3,4]. Furthermore, biochemical markers of bone remodeling are a valuable supplement to bone mineral density measurement (BMD), as they provide a dynamic measure of the current bone turnover state compared with the static measure of skeletal status provided by BMD. Thus, biochemical markers of bone turnover provide a rapid assessment of the effects of antiresorptive therapies such as hormone replacement therapy, bisphosphonates, and calcitonin which induce a decrease in the levels of bone markers that is correlated with the long-term effect of such treatments on bone mass [5][6][7][8][9][10][11][12][13][14][15]. Due to the small annual changes in BMD, the effect...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Bone Resorption in Post-menopausal Women with Normal and Low BMD Assessed with Biochemical Markers Specific for Telopeptide Derived Degradation Products of Collagen Type I

Reginster¹,

Henrotin

Christiansen

et al. 2001

Calcif Tissue Int

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“…Changes in bone turnover may occur with age in men 14,15 and are correlated with levels of bone mass in both men and women. 16 In our Figure 1 Urine NTX, (mean (s.e.)) in Groups 1, 2 and 3.…”

Section: Discussionmentioning

confidence: 61%

Bone loss associated with the use of LHRH agonists in prostate cancer

Peters¹,

Fairney

Kyd

et al. 2001

Prostate Cancer Prostatic Dis

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Hypogonadism is a recognised cause of osteoporosis in men. When patients with advanced prostate cancer are treated with luteinising hormone releasing hormone (LHRH) agonist analogues their circulating testosterone levels decline and these patients may develop fractures.We have undertaken a cross-sectional study on a cohort of patients treated with goserelin (n ¼ 41) and compared their bone density and bone turnover with patients with prostate cancer not on goserelin and elderly patients living in the community.There was no difference in bone density between the patients on treatment and those living in the community and there was a similar incidence of osteoporosis (50 and 42%, respectively). The bone marker measurements were higher in the treated patients: urine N-telopeptide (NTX) 80.1 (9) (mean (s.e.)) BCE/mmol, compared to 30.1 (2.9), P < 0.001 in elderly patients; and bone alkaline phosphatase 41.9 (6.1) u/l in treated patients and 20.7 (1.5) in untreated prostate cancer patients, P < 0.002. Patients on treatment with radionuclide scan evidence of metastases did not have higher bone marker values than those with negative scans.As increased bone turnover and low bone density are associated with enhanced risk of osteoporotic fractures, we suggest that patients on LHRH agonist analogues should receive advice and possibly anti-bone resorptive treatment with bisphosphonates to prevent further bone loss and fractures. Prostate Cancer and Prostatic Diseases (2001) 4, 161-166.

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“…Patients on letrozole showed an increase in Creactive protein, a biomarker of inflammation, within the first 6 months after treatment start; however, that increase was not specifically correlated with arthralgia 23 . Urinary N-telopeptide of type i collagen is a marker of bone resorption and distinguishes normal, osteopenic, and osteoporotic bone mineral density levels 24 . Our rationale for selection of biomarkers was to test the potential effects on pain increase of the rate of estrogen depletion, of initial vitamin D status, and of pre-existing onset of bone loss.…”

Section: Introductionmentioning

confidence: 99%

A Prospective Pilot Study Investigating the Musculoskeletal Pain in Postmenopausal Breast Cancer Patients Receiving Aromatase Inhibitor Therapy

et al. 2011

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Background: Although arthralgia is a known adverse effect of aromatase inhibitor (ai) treatment in postmenopausal breast cancer patients, few studies have carried out a comprehensive evaluation of the nature, onset, and incidence of musculoskeletal (msk) pain in these patients. We therefore used a pilot study to identify conditions or markers predictive of pain. Methods: For 24 weeks, we monitored 30 eligible postmenopausal women starting ai therapy. Pre-existing and incident msk conditions and pain were assessed clinically and with ultrasonography of the hands and wrists. In addition, patient questionnaires were used to assess pain before and during ai therapy. Biochemical markers were measured at baseline and at regular intervals after anastrozole therapy began. Gene profiling studies were carried out before and 48 h after the initial ai administration. Results: Over the 24-week study period, 20 participants (67%) showed no pain symptoms; 5 (17%) experienced low or moderate pain at baseline, which did not increase with ai treatment; and during therapy, 5 (17%) showed exacerbation of pain attributable to osteoarthritis of the hand and to finger flexor tenosynovitis. Although all 30 participants had some degree of msk conditions before anastrozole therapy started, the pre-existing conditions did not necessarily predispose the women to increased pain during anastrozole treatment. Higher levels of urinary N-telopeptides of type i collagen were associated with the groups presenting pain, suggesting a higher extent of pre-existing bone resorption, without significant evolution over the 24-week treatment period. Slightly higher levels of 1,25(OH)2 vitamin D3 were observed at baseline in patients with pain increase, but did not significantly change during treatment; however, average levels of 25(OH) vitamin D3 increased, likely because of supplementation. Although biochemical markers did not discriminate efficiently between pain groups, a signature of 166 genes in peripheral blood mononuclear cells was identified that could stratify patients into the various groups observed in this pilot study. The gene signature was enriched in components of inflammatory signalling and chemokine expression, of antitumoural immunity pathways, and of metabolic response to hormones and xenobiotics, although no clinically significant association could be made in the present study, considering the small number of patients. Nevertheless, the observed trend suggests the feasibility of developing surrogate predictive markers of msk pain. Patient compliance was high in this study and was not affected by pain exacerbation. Conclusions: Baseline msk assessment showed pre-existing causes for pain in most of the study patients before initiation of the ai. Exacerbation of existing osteoarthritis pain and tenosynovial symptoms was the primary cause of pain increase. Musculoskeletal pain assessment at baseline and prompt treatment of pain symptoms may help to optimize adherence to ai therapy. The value of routinely assessing inflammatory markers such as C-reactive protein and erythrocyte sedimentation rate was not supported by our pilot study. Gene expression profiles in peripheral blood mononuclear cells may be further explored in larger-scale studies as stratification markers to identify patients at risk of developing arthralgia.

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Urinary N-telopeptide levels discriminate normal, osteopenic, and osteoporotic bone mineral density

Abstract: The levels of NTX uniquely discriminated between older adults with normal, osteopenic, or osteoporotic BMD levels. If confirmed, these data suggest that NTX levels could be used to predict current osteoporosis in older men and women.

Cited by 48 publications

References 0 publications

Bone Resorption in Post-menopausal Women with Normal and Low BMD Assessed with Biochemical Markers Specific for Telopeptide Derived Degradation Products of Collagen Type I

Bone Resorption in Post-menopausal Women with Normal and Low BMD Assessed with Biochemical Markers Specific for Telopeptide Derived Degradation Products of Collagen Type I

Bone loss associated with the use of LHRH agonists in prostate cancer

A Prospective Pilot Study Investigating the Musculoskeletal Pain in Postmenopausal Breast Cancer Patients Receiving Aromatase Inhibitor Therapy

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