Can bone turnover markers correlate bone mass at the hip and spine according to menopausal period?

Association of Serum Periostin Level with Classical Bone Turnover Markers and Bone Mineral Density in Shanghai Chinese Postmenopausal Women with Osteoporosis

Background

It has been reported that serum periostin levels are significantly higher in postmenopausal patients with osteoporotic fractures. Nonetheless, the levels of serum periostin in postmenopausal women with different bone mass remain unclear.

Purpose

The objective of the study was to identify the levels of serum periostin in Chinese postmenopausal women with different bone mass, and the correlations between the periostin levels and the classical bone turnover markers (BTMs), and bone mineral densities (BMDs) at different sites.

Patients and Methods

This study enrolled 331 Chinese postmenopausal women in Shanghai; their clinical features were collected; their levels of serum periostin and traditional BTMs were measured by ELISA or the fully automated immunoassay analyzer; their BMDs at different sites were measured by dual-energy X-ray absorptiometry (DXA).

Results

According to the T-value of bone mineral density (BMD), these postmenopausal women were divided into normal group (n=84), osteopenia group (n=126) and osteoporosis group (n=121). There was no significant difference in the serum periostin levels among the above three groups of subjects. In addition, Spearman correlation analysis also revealed that no correlation was observed between the value of serum periostin and those of traditional BTMs, and BMDs at different sites, respectively. The values of traditional BTMs were negatively correlated with those of BMDs at all measured sites. Furthermore, the receiver-operating characteristic (ROC) curves analysis indicated that among the periostin and traditional BTMs mentioned above, the best predictors for postmenopausal osteoporosis in Shanghai Chinese postmenopausal women were osteocalcin (OC) and procollagen type 1 N-terminal propeptide (P1NP) [the areas under the ROC curve (AUC)=0.746 and 0.761, respectively].

Conclusion

Serum periostin may not be used as a marker of systemic bone metabolism in Shanghai Chinese postmenopausal women without prior fracture. In addition, serum P1NP and OC levels may be the predictors of osteoporosis occurrence in Chinese postmenopausal women.

Associations between the serum levels of selected bone turnover markers and biological traits in nursing home women aged 80+ without inflammation. A pilot study

BACKGROUND

Bone turnover markers (BTM) reflect the status of bone remodeling processes responsible for bone mineral density. The existing body of evidence that osseous tissue can interact with many other body tissues and organs suggests that the cross-talks can lead to different relationships. The biological traits associated with BTMs have not been thoroughly studied in the elderly despite bone turnover being known to increase with age.

OBJECTIVE

To determine whether the C-terminal crosslinking telopeptides of type I collagen (CTXI) and the serum levels of total (TAP) and bone-specific (BAP) alkaline phosphatase are associated with the biological traits in nursing home women aged 80-92 years without inflammation and, if so, to indicate the best predictors of these BTM's blood concentrations.

METHODS

A group of 64 female volunteers aged 80 years and older, the residents of nursing homes, were screened for the study. Fifty two women were ineligible as they met the exclusion criteria. As a result, the study group consisted of 12 participants (85.1 ± 3.9 years; 58.1 ± 8.7 kg; 1.52 ± 0.06 m), all having blood C-reactive protein (CRP) levels below 3 mg/l. Also assessed were the participants' morphology, glucose and insulin levels, lipid profiles, CTXI, TAP, and BAP. Other measured parameters included body composition, resting heart rate and arterial blood pressure, isometric knee extension peak torque (IKEPT), and walking capacity (6-min walk test). The statistical analysis was performed using Pearson's correlation coefficients, the Benjamini-Hochberg procedure, and a stepwise multiple regression analysis with backward elimination.

RESULTS

Inverse correlations were found between CTX-I and hemoglobin concentration (HGB) (r = -0.680; p = .015), red blood cells count (RBC) (r = -0.664; p = .019), fat-free mass (r = -0.633; p = .027), body weight (r = -0.589; p = .044), and total cholesterol (r = -0.581; p = .048). The multiple regression analysis of CTX-I showed that body weight was the only independent variable that was statistically significant (r2 = 0.346; p < .05; SEE = 0.347 ng/ml). BAP was positively correlated with double product (DP) (r = 0.742; p = .006), RBC (r = 0.650; p = .022), HGB (r = 0.637; p = .026), mean arterial pressure (MAP) (r = 0.622; p = .031), diastolic blood pressure (DBP) (r = 0.612; p = .034), body height (r = 0.603; p = .038), IKEPT (r = 0.565; p = .056), and systolic blood pressure (SBP) (r = 0.538; p = .071). BAP, a dependent variable, was the most closely correlated with DP (r² = 0.550; p < .01; SEE = 9.161 U/l). TAP was also significantly associated with DP (r = 0.775; p = .003), with the association being stronger than between BAP and DP (r² = 0.600; p < .01; SEE = 1000.5 beats/min*mm Hg).

CONCLUSIONS

In relatively healthy the oldest-old nursing home women without inflammation, total body weight was the best predictor of bone resorption shown by the CTX-I concentration, whereas the rate pressure product (DP) turned out to best predict osteoblastic activity determinable from serum alkaline phosphatase activity. The results of the study suggest that the activity of serum TAP and BAP can be enhanced by different mechanisms.

Related factors in bone mineral density of lumbal and femur in natural postmenopausal women

OBJECTIVE

To assess possible factors affecting the bone mineral density (BMD) in postmenopausal women.

METHODS

A retrospective analysis of 267 cases with spontaneous menopause within 3 years of period was performed. None of the enrolled cases were taken any hormone replacement therapy and/or treatment for osteoporosis. BMD measurements were done in lumbal vertebral (L1-L4) and left femur (neck, intertrochanteric and ward triangle) via dual energy X-ray absorbtiometry (DEXA) method, yielding corresponding T-scores of above-mentioned areas. In addition, age at menarche, parity, menopausal age, duration of postmenopausal state, lactation, physical activity, cigarette smoking, dietary calcium intake, oral contraceptive use and body mass index (BMI) were determined.

RESULTS

There were no relationships between BMD and age at menarche, parity, menopausal age, lactation, physical activity, smoking, dietary calcium intake and oral contraceptive use. Two associated factors with BMD were BMI and time since menopause. BMI was found to be positively and time since menopause was negatively correlated with BMD of both lumbal region and femur.

CONCLUSIONS

BMD changes and its related factors should be kept in mind during postmenopausal years. Therefore, adequate peak bone mass and related life style measures should be achieved to confront osteoporosis-related symptoms and its consequences.

Biomarkers of bone turnover can be assayed from human saliva

The purpose of this study was to determine if biomarkers of bone turnover [deoxypyridinium (D-PYR) or osteocalcin (OC)] could be detected in human saliva. These biomarkers have been measured in ovariectomized sheep saliva, but not in human saliva. Saliva was collected from 37 women. The bone mineral density of the calcaneus was assessed by quantitative ultrasound and expressed as a T score. Salivary D-PYR and OC concentrations were determined by enzyme-linked immunosorbent assay. Data were analyzed by a Spearman's rho correlation test and factorial analysis of variance was followed by a post hoc Tukey's test. There were significant correlations between age, body mass index, D-PYR, or OC concentration and calcaneus T scores (p<.05), suggesting that saliva could be used as a fluid for assay of human biomarkers of bone turnover. Our data suggest a beneficial use of saliva in situations where a large number of patients are to be screened for metabolic bone diseases.

Evaluation of urine deoxypyridinoline and bone mineral density in 861 Chinese during routine health examination

The aim of this study was to investigate the interrelation among urine deoxypyridinoline (DPD), age, sex, and bone mineral density (BMD) and to clarify whether DPD can be used to screen for low bone mass (T-score <-1) of the lumbar spine and proximal femur in the Chinese population. We reviewed medical records over a 1-yr period of all subjects who completed an annual health examination. A total of 302 men (age: 48.20 +/- 10.86 yr) and 559 women (age: 46.45 +/- 11.16 yr) who lived in the Taipei area, had no major systemic disorders, and underwent urine DPD test and BMD examination of both the lumbar spine (L-BMD) and proximal femur (F-BMD) were recruited. The urine DPD was weakly correlated with middle age in men (r = 0.154, p < 0.01). There was no correlation between DPD and age in women. The DPD and L-BMD were weakly correlated in both middle-aged men (r = -0.165, p < 0.05) and women (r = -0.171, p < 0.01), and moderately correlated in elderly women (r = -0.315, p < 0.01). There was a higher correlation between DPD and F-BMD in men than in women, especially in the middle-aged groups (men: r = -0.258, p < 0.01; women: r = -0.170, p < 0.01). Women in the highest tertile of DPD had 2.40 times the risk (95% confidence interval: 1.49-3.85) of those in the lowest tertile after age adjustment. There was poor agreement or none between DPD and BMD measurements in patients with low bone mass at either site in either sex. Urine DPD tests to substitute for BMD measurements in routine health examination for Chinese is not recommended.

Bone turnover and body weight relationships differ in normal-weight compared with heavier postmenopausal women

Low body weight is associated with increased risk for fractures, whereas higher body weight has been shown to be protective against osteoporosis. This study evaluated whether body weight plays a role regulating bone turnover and mass in normal-weight (body mass index (BMI) <25 kg/m2), overweight (BMI 25-29.9 kg/m2) and obese (BMI> or =30 kg/m2) postmenopausal women who were either receiving hormone replacement therapy [HRT(+)] or not [HRT(-)] (total of six groups). Body weight, BMI, total body bone mineral content (TBBMC), and markers of bone formation (serum osteocalcin) and bone resorption (urinary pyridinoline (PYD) and deoxypyridinoline) were retrospectively analyzed in 210 postmenopausal women. The mean age was 67+/-6 years, with mean body weight of 70.8+/-14.2 kg, ranging from 45.0 to 115.5 kg. Body weight was positively correlated with TBBMC ( r=0.50, p<0.0001). There was a lower TBBMC and higher bone formation rate in normal-weight than obese HRT(-) women, but in women taking HRT there were no differences between BMI categories. In addition, in normal-weight HRT(-) women only, PYD and body weight showed a negative correlation (r=-0.39, p=0.01). Among normal-weight, but not overweight or obese subjects, we observed higher TBBMC and lower bone turnover in the HRT(+) compared with the HRT(-) group. Regression models explained 36% of the variance in TBBMC, mainly through body weight. Additional models could only explain 11-15% of the variance in bone turnover. Taken together, these data suggest that among normal-weight but not obese postmenopausal women, higher bone turnover is associated with lower bone mass, and that only normal-weight women show a different bone turnover profile with HRT treatment. Body weight should be considered an important factor in bone metabolism with relevant clinical implications.

Immunomagnetic tumor cell enrichment is promising in detecting circulating breast cancer cells

OBJECTIVE

Magnetic-activated cell separation (MACS) for the enrichment of tumor cells was evaluated with immunocytochemistry (ICC) and flow cytometry (FCM).

METHODS

Blood (20 ml) was sampled in 36 affected patients before surgery. Nucleated blood cells were obtained with the removal of red blood cells in the buffy coat. Nucleated blood cells (2 x 10(6)) from breast cancer patients were aliquoted before enrichment for direct immunostaining (ICC group), while all remaining cells were enriched and then immunostained (MACS/ICC group). Breast cancer cell lines were spiked serially in normal nucleated blood cells for FCM evaluation of the enrichment efficiency of MACS.

RESULTS

The enrichment rate of spiked tumor cells was 37- to 2,300-fold and was negatively correlated with the ratio of tumor cells to normal nucleated cells (p < 0.05). The positive rate was only 5.6% (2/36) in the ICC group and was as high as 38.9% (14/36) in the MACS/ICC group (p < 0.001). The positivity in the enriched fraction was 0% (0/4), 33.3% (8/24), 60% (3/5) and 100% (3/3) for tumors at stages I, II, III and IV, respectively (p < 0.05).

CONCLUSION

MACS can enrich circulating tumor cells, and the presence of circulating breast cancer cells correlates with clinical staging.