Current Recommendations for Laboratory Testing and Use of Bone Turnover Markers in Management of Osteoporosis

Lee, Jehoon; Vasikaran, Samuel

doi:10.3343/alm.2012.32.2.105

Cited by 125 publications

(107 citation statements)

References 55 publications

(58 reference statements)

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“…The byproducts of bone turnover may provide insight into acute bone metabolism (Wheater et al 2013) including resorption by osteoclasts and formation by osteoblasts (Naylor and Eastell 2012;Burch et al 2014). Gold-standard markers of bone resorption (CTx) and formation (P1NP) (Lee and Vasikaran 2012) have not been measured in patients with PAH deficiency, or with factors such as dietary intake, compliance with dietary treatment (phenylalanine restriction and medical food), and blood phenylalanine concentrations. The primary aim of this study was to assess the impact of dietary intake and nutrient source (food versus medical food) on BMD and gold-standard BTM (Lee and Vasikaran 2012) in patients with PAH deficiency.…”

Section: Introductionmentioning

confidence: 99%

“…Bone mineral density is a good indicator of bone status, but bone turnover markers (BTM) are valuable indicators of dynamic bone remodeling (Lee and Vasikaran 2012). The byproducts of bone turnover may provide insight into acute bone metabolism (Wheater et al 2013) including resorption by osteoclasts and formation by osteoblasts (Naylor and Eastell 2012;Burch et al 2014).…”

Section: Introductionmentioning

confidence: 99%

“…Gold-standard markers of bone resorption (CTx) and formation (P1NP) (Lee and Vasikaran 2012) have not been measured in patients with PAH deficiency, or with factors such as dietary intake, compliance with dietary treatment (phenylalanine restriction and medical food), and blood phenylalanine concentrations. The primary aim of this study was to assess the impact of dietary intake and nutrient source (food versus medical food) on BMD and gold-standard BTM (Lee and Vasikaran 2012) in patients with PAH deficiency. Secondary aims were to assess differences across age categories and correlations among bone biomarkers.…”

Section: Introductionmentioning

confidence: 99%

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Impact of Dietary Intake on Bone Turnover in Patients with Phenylalanine Hydroxylase Deficiency

et al. 2017

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Phenylalanine hydroxylase (PAH) deficiency is a genetic disorder characterized by deficiency of the PAH enzyme. Patients follow a phenylalanine-restricted diet low in intact protein, and must consume synthetic medical food (MF) to supply phenylalanine-free protein. We assessed relationships between dietary intake and nutrient source (food or MF) on bone mineral density (BMD) and bone turnover markers (BTM) in PAH deficiency. Blood from 44 fasted females 11-52 years of age was analyzed for plasma phenylalanine, serum BTM [CTx (resorption), P1NP (formation)], vitamin D, and parathyroid hormone (PTH). BTM ratios were calculated to assess resorption relative to formation (CTx/P1NP). Dual energy X-ray absorptiometry measured total BMD and age-matched Zscores. Three-day food records were analyzed for total nutrient intake, nutrients by source (food, MF), and compliance with MF prescription. Spearman's partial coefficients (adjusted for age, BMI, energy intake, blood phenylalanine) assessed correlations. All had normal BMD for age (Z-score >À2). Sixty-four percent had high resorption and normal formation indicating uncoupled bone turnover. CTx/P1NP was positively associated with food phenylalanine (r 2 ¼ 0.39; p-value ¼ 0.017), energy (r 2 ¼ 0.41; p-value ¼ 0.011) and zinc (r 2 ¼ 0.41; pvalue ¼ 0.014). CTx/P1NP was negatively associated with MF fat (r 2 ¼ À0.44; p-value ¼ 0.008), MF compliance (r 2 ¼ À0.34; p-value ¼ 0.056), and positively with food sodium (r 2 ¼ 0.43; p-value ¼ 0.014). CTx/ P1NP decreased significantly with age (p-value ¼ 0.002) and higher PTH (p-value ¼ 0.0002). Phenylalanine was not correlated with any bone indicator. Females with PAH deficiency had normal BMD but elevated BTM, particularly resorption. More favorable ratios were associated with nutrients from MF and compliance. Younger females had less favorable BTM ratios. Promoting micronutrient intake through compliance with MF may impact bone metabolism in patients with PAH deficiency. Synopsis: Bone mineral density was normal in 44 females with PAH deficiency; however, bone turnover markers suggested uncoupling of bone resorption and formation, particularly in younger patients. Adequate nutrient intake from medical food and overall medical food compliance may positively impact bone turnover.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Impact of Dietary Intake on Bone Turnover in Patients with Phenylalanine Hydroxylase Deficiency

et al. 2017

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“…With regard to bone formation, the production phase of the collagen matrix coincides with increased alkaline phosphatase activity, while mineralization process coincides closely with osteocalcin (Tables 2 and 3). In contrast, bone turn over markers (BTM) are frequently used in clinical trials and to provide valid information about the effectiveness of osteoporosis treatment, reflecting the state of bone metabolism and its response to treatment, although they are not useful alone to estimate bone loss (8).…”

mentioning

confidence: 99%

Bone markers and osteoporosis therapy

Bandeira

Costa

Filho

et al. 2014

Arq Bras Endocrinol Metab

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Several factors are involved in determining bone quality including bone density, bone turnover, the extent of trabecular bone connectivity, cortical porosity and geometry. Metabolically active and in a continuous process of remodeling, approximately 20% of bone tissue is renewed annually. Bone turn over markers (BTM) are frequently used in clinical trials and to provide valid information about the effectiveness of osteoporosis treatment, reflecting the state of bone metabolism and its response to treatment, although they are not useful alone to estimate bone loss. In this review the behavior of BTM from different clinical trials or different osteoporotic drugs will be addressed. Arq Bras Endocrinol Metab. 2014;58(5):504-13 Keywords Bone markers; osteoporosis; bone density ReSumoDiversos fatores estão envolvidos na determinação da qualidade óssea, incluindo a densidade óssea, a remodelação óssea, a extensão da conectividade do osso trabecular, porosidade cortical e geometria. Metabolicamente ativo e, em um processo contínuo de remodelação, cerca de 20% do tecido ósseo é renovado anualmente. Por sua vez, marcadores de turnover ósseo (BTM) são frequentemente utilizados em estudos clínicos e fornecem informações válidas sobre a eficácia do tratamento da osteoporose, o que reflete o metabolismo ósseo e sua resposta ao tratamento, embora eles não sejam úteis somente para estimar a perda óssea. Nesta revisão, o comportamento dos BTM em ensaios clínicos diferentes e com diferentes drogas osteoporóticas será abordado. one is a specific type of tissue composed primarily of type I collagen impregnated with minerals in the form of hydroxyapatite crystals. Several factors are involved in determining bone quality including bone density, bone turnover, the extent of trabecular bone connectivity, cortical porosity and geometry (Figure 1) (1). Metabolically active and in a continuous process of remodeling, approximately 20% of bone tissue is renewed annually (2). This complex process begins at birth and is maintained throughout life. The active cellular participants in this process, often configured as multiple multicellular units, are osteoclasts, osteoblasts and osteocytes.The system is highly regulated by many factors. For example, osteoprotegerin (OPG) (osteoprotegerin), receptor activator of NF-kappaB (RANK) and its cognate ligand, (RANKL), form a metabolic regulatory system focused upon bone resorption (3). Additionally there are other factors that influence bone turnover, such as parathyroid hormone (PTH), 1,25-dihydroxyvitamin D (calcitriol), prostaglandin E2 and interleukins (4). The process of bone turnover leads to the release of factors that give highly relevant information on rates of bone formation and resorption (Figure 2).

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“…More than 99% of the total body calcium is stored in bone in the form of phosphate and hydroxide salts, predominantly as hydroxyapatite 6 . Calcium and vitamin D have a modest effect on reducing bone loss or improving bone mineral density and decreasing fracture risk, especially in subjects with adequate calcium 7 …”

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confidence: 99%

Thyroid function determinants, calcium, phosphate and vitamin D in adult male smokers in Calabar, Nigeria

Bassey¹,

Akpan²,

Elijah³

et al. 2018

J Med Allied Sci

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Current Recommendations for Laboratory Testing and Use of Bone Turnover Markers in Management of Osteoporosis

Cited by 125 publications

References 55 publications

Impact of Dietary Intake on Bone Turnover in Patients with Phenylalanine Hydroxylase Deficiency

Impact of Dietary Intake on Bone Turnover in Patients with Phenylalanine Hydroxylase Deficiency

Bone markers and osteoporosis therapy

Thyroid function determinants, calcium, phosphate and vitamin D in adult male smokers in Calabar, Nigeria

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