Comparison of clinical cut-points and treatment targets for urine NTX and plasma βCTX-I in osteoporosis

Madendağ

BMC Pregnancy Childbirth

et al. 2018

BackgroundNausea and vomiting occur 50–90% during the first trimester of pregnancy. However, patients with hyperemesis gravidarum (HG) may be hospitalized at an incidence rate of 0.8–2% before the 20th week of gestational age. The symptoms generally start during the 5–6th gestational weeks, reaching the highest degree during the 9th week, and decline after the 16–20th weeks of gestation. Clinical findings are proportional to the severity of the disease and severe HG is characterized with dehydration, electrolyte imbalance, and nutritional deficiency as a result of vomiting.MethodsThe study population consisted of two groups of pregnant volunteers at 5–12 weeks of gestation: a severe HG group and a control group. The HG severity was scored using the Pregnancy-Unique Quantification of Emesis (and nausea) (PUQE).The serum levels of the maternal Ca, parathyroid hormone (PTH), Na, K, blood urea nitrogen(BUN), creatinine, vitamin D(25OHD3), and the maternal urine NTx levels were compared between the groups.ResultsIn total, 40 volunteers were enrolled in this study: 20 healthy pregnant volunteers and 20 with severe HG. There were no statistically significant differences between the maternal characteristics. The first trimester weight loss of ≥5 kg was significantly higher in the severe HG group (p < 0.001), while the control group had a significantly higher sunlight exposure ratio than the severe HG group (p = 0.021). The urine NTx levels were significantly higher in the severe HG group (39.22 ± 11.68NTx/Cre) than in the control group(32.89 ± 8.33NTx/Cre) (p = 0.028).The serum Ca, PTH, Na, K, BUN, and creatinine levels were similar between the groups (p = 0.738, p = 0.886, p = 0.841, p = 0.957, p = 0.892, and p = 0.824, respectively). In the severe HG group, the serum 25OHD3 levels were significantly lower than in the control group (p < 0.001).ConclusionsThe data from this study indicated that severe HG is associated with increased urine NTx levels. However, large-scale studies are required to understand the clinical significance of this finding, as well as the long-term consequences of elevated urine NTx levels and the underlying mechanisms.Trial registrationNCT02862496 Date of registration: 21/07/2016.

Section: Discussionmentioning

confidence: 99%

Maternal type 1collagen N-terminal telopeptide levels in severe hyperemesis gravidarum

Madendağ

BMC Pregnancy Childbirth

et al. 2018

“…Due to existing controversy concerning reference intervals of BTMs, for classification we used as cutoffs values recently proposed optimal treatment targets for anti-resorptive therapy. It worthy of mention in this connection that many, but not all 1 , 12 , studies suggested that P1NP and bCTX may provide information about both response to treatment and reduction of fracture risk following osteoporotic therapy with antiresorptive 7 , 23 , 24 , 26 , 48 , 51 , 52 or anabolic 6 , 53 - 59 agents. Almost all published studies demonstrated reduction in serum bCTX during antiresorptive therapy and rise in serum P1NP during therapy with teriparatide; these changes have been associated with an improvement in BMD and reduced fracture risk.…”

Section: Discussionmentioning

confidence: 99%

“…Because the reports on thresholds of optimal bone metabolism, particularly in the older age, are controversial, to classify bone turnover status we used the cutoffs proposed as therapeutic (fracture-protective) targets, though some researchers concluded “that absolute values for BTMs are not suited as treatment targets” 12 . Two approaches were recommended to choose treatment targets for osteoporotic therapy: (1) provisional threshold values derived from community-dwelling observations 22 - 24 and (2) the mean/median of premenopausal reference intervals 7 , 25 , 26 . As a provisional treatment target /threshold for optimal anti-resorptive response values of bCTX ≤0.230 µg/L (Chubb S 2016; 2017) and ≤0.250 µg/L (the equivalent of urinary NTX <21 nmol BCE/mmol 22 ) were recommended.…”

Section: Methodsmentioning

confidence: 99%

Bone Turnover Status: Classification Model and Clinical Implications

Fisher¹,

Fisher²,

Srikusalanukul³

et al. 2018

Int. J. Med. Sci.

Aim: To develop a practical model for classification bone turnover status and evaluate its clinical usefulness.Methods: Our classification of bone turnover status is based on internationally recommended biomarkers of both bone formation (N-terminal propeptide of type1 procollagen, P1NP) and bone resorption (beta C-terminal cross-linked telopeptide of type I collagen, bCTX), using the cutoffs proposed as therapeutic targets. The relationships between turnover subtypes and clinical characteristic were assessed in1223 hospitalised orthogeriatric patients (846 women, 377 men; mean age 78.1±9.50 years): 451(36.9%) subjects with hip fracture (HF), 396(32.4%) with other non-vertebral (non-HF) fractures (HF) and 376 (30.7%) patients without fractures.Resalts: Six subtypes of bone turnover status were identified: 1 - normal turnover (P1NP>32 μg/L, bCTX≤0.250 μg/L and P1NP/bCTX>100.0[(median value]); 2- low bone formation (P1NP ≤32 μg/L), normal bone resorption (bCTX≤0.250 μg/L) and P1NP/bCTX>100.0 (subtype2A) or P1NP/bCTX<100.0 (subtype 2B); 3- low bone formation, high bone resorption (bCTX>0.250 μg/L) and P1NP/bCTX<100.0; 4- high bone turnover (both markers elevated ) and P1NP/bCTX>100.0 (subtype 4A) or P1NP/bCTX<100.0 (subtype 4B). Compared to subtypes 1 and 2A, subtype 2B was strongly associated with nonvertebral fractures (odds ratio [OR] 2.0), especially HF (OR 3.2), age>75 years and hyperparathyroidism. Hypoalbuminaemia and not using osteoporotic therapy were two independent indicators common for subtypes 3, 4A and 4B; these three subtypes were associated with in-hospital mortality. Subtype 3 was associated with fractures (OR 1.7, for HF OR 2.4), age>75 years, chronic heart failure (CHF), anaemia, and history of malignancy, and predicted post-operative myocardial injury, high inflammatory response and length of hospital stay (LOS) above10 days. Subtype 4A was associated with chronic kidney disease (CKD), anaemia, history of malignancy and walking aids use and predicted LOS>20 days, but was not discriminative for fractures. Subtype 4B was associated with fractures (OR 2.1, for HF OR 2.5), age>75 years, CKD and indicated risks of myocardial injury, high inflammatory response and LOS>10 days.Conclusions: We proposed a classification model of bone turnover status and demonstrated that in orthogeriatric patients altered subtypes are closely related to presence of nonvertebral fractures, comorbidities and poorer in-hospital outcomes. However, further research is needed to establish optimal cut points of various biomarkers and improve the classification model.

“…84 The goal of anti-resorptive treatment is to achieve a decrease in BTMs into the lower half of the premenopausal range 1-3 months after intravenous treatment or 3-6 months after oral treatment. 94 97 In contrast, following OP treatment with teriparatide, an increase in P1NP by >10 mg/L from baseline within 1-3 months has been proposed as an indication of response to therapy. 94 The advantage of serum P1NP is its ability to assess both osteoanabolic and anti-remodelling therapies in monitoring postmenopausal OP.…”

Section: Clinical Usementioning

confidence: 99%

Harmonization of commercial assays for PINP; the way forward

et al. 2020

Osteoporosis (OP) is a condition where there is low bone density and microarchitectural deterioration which can predispose to fragility fractures. There is a wealth of literature on OP from the developed countries, but less so from Asia. This review will explore the field of OP research in SouthEast Asia with regard to the epidemiology, the diagnosis of OP and the role of laboratory tests in the management of OP, with emphasis on 25-dihydroxyvitamin D and bone turnover markers.