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Berggren SS, Dahlgren J, Andersson O, Bergman S, Roswall J. Reference limits for osteocalcin in infancy and early childhood: A longitudinal birth cohort study. Clin Endocrinol (Oxf) 2024; 100:399-407. [PMID: 38385947 DOI: 10.1111/cen.15036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/26/2024] [Accepted: 02/08/2024] [Indexed: 02/23/2024]
Abstract
OBJECTIVE The longitudinal variations in serum levels of the hormone osteocalcin is largely unknown during infancy and early childhood. Our aim was to establish reference limits for total serum osteocalcin during specific time points from birth until 5 years of age and present those in the context of sex, breastfeeding practices and gestational age (GA). DESIGN Blood samples from 551 Swedish children were analysed at birth, 4, 12, 36 and 60 months of age. Total serum osteocalcin was measured using the IDS-iSYS N-MID Osteocalcin assay technique. Information about the mother, birth, anthropometrics and a food diary were collected. RESULTS Sex-specific and age-specific reference limits were established for the five time points. The median osteocalcin levels over time were 40.8, 90.0, 67.8, 62.2 and 80.9 μg/L for boys and 38.1, 95.5, 78.3, 73.9 and 92.6 μg/L for girls. Lower GA was associated to higher osteocalcin at birth, and ongoing breastfeeding was associated to higher osteocalcin levels. CONCLUSION Osteocalcin followed a wavelike pattern with low levels in the umbilical cord and a postnatal peak during the first year which then declined and rose again by the age of five. Knowledge of this wavelike pattern and association to factors as sex, breastfeeding and GA may help clinicians to interpret individual osteocalcin levels and guide in future research.
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Affiliation(s)
- Sara S Berggren
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Health Center Hyltebruk, Hyltebruk, Halland, Sweden
| | - Jovanna Dahlgren
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Pediatrics, Västra Götalandregion, Queen Silvia Children's Hospital, Lund, Sweden
| | - Ola Andersson
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Stefan Bergman
- Department of Public Health and Community Medicine, Primary Health Care Unit, University of Gothenburg, Gothenburg, Sweden
- Spenshult Research and Development Centre, Halmstad, Sweden
| | - Josefine Roswall
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Pediatrics, Halland Hospital Halmstad, Halmstad, Sweden
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Current use of bone turnover markers in the management of osteoporosis. Clin Biochem 2022; 109-110:1-10. [PMID: 36096182 DOI: 10.1016/j.clinbiochem.2022.09.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/31/2022] [Accepted: 09/01/2022] [Indexed: 11/21/2022]
Abstract
The adult bone is continuously being remodelled to repair microdamage, preserve bone strength and mechanical competence as well as maintain calcium homeostasis. Bone turnover markers are products of osteoblasts (bone formation markers) and osteoclasts (bone resorption markers) providing a dynamic assessment of remodelling (turnover). Resorption-specific bone turnover markers are typically degradation products of bone collagen molecules (N- [NTX] and C-telopeptide cross-linked type 1 collagen [CTX]), which are released into the circulation and excreted in urine; or enzymatic activities reflecting osteoclastic resorption, tartrate-resistant acid phosphatase [TRACP]. Formation-specific bone turnover markers embrace different osteoblastic activities: type 1 collagen synthesis (Procollagen type I N- propeptide [PINP]), osteoblast enzymes (bone-specific alkaline phosphatase [BALP]), or bone matrix proteins [osteocalcin]. Among individuals not receiving osteoporosis treatment, resorption and formation markers are tightly linked and highly correlated (r= 0.6-0.8). Significant biological variability was reported in the past, but these issues have been greatly improved with automated assays and attention to pre-analytical and analytical factors that are known to influence bone turnover marker levels. Bone turnover markers are not useful in the diagnosis of osteoporosis, the individual prediction of bone loss, fracture, or rare complications, or in the selection of pharmacological treatment. Despite remaining issues with reference intervals and assays harmonization, bone turnover markers have proven to be useful in elucidating the pharmacodynamics and effectiveness of osteoporosis medications in clinical trials. As an alternative to BMD testing, BTMs may be useful to monitor osteoporosis therapies.
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Bone and fat mass in relation to postnatal levels of insulin-like growth factors in prematurely born children at 4 y of age. Pediatr Res 2014; 75:544-50. [PMID: 24441105 DOI: 10.1038/pr.2014.4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 09/27/2013] [Indexed: 12/14/2022]
Abstract
BACKGROUND Children born prematurely may be at risk of developing osteopenia. This study investigated whether insulin-like growth factors (IGFs) in the early postnatal period influence bone mass and body composition in prematurely born children. METHODS A total of 74 control (gestational age >36 wk; n = 37) and preterm (gestational age <32 wk; n = 37) infants were investigated (mean age ± SD: 4.59 ± 0.31 y). Bone mineral density, body composition, and markers of bone and mineral metabolism were investigated in relation to postnatal IGF levels. RESULTS After adjusting for confounders, we found no differences in bone mass, but significantly less lean mass, increased fat mass, and increased osteocalcin levels in ex-preterm infants. Forward stepwise multiple analysis revealed that higher late postnatal IGF-II levels predict lumbar spine bone mineral content (P < 0.05) and lean mass (P < 0.05). When the birth weight standard deviation score was included in the analysis, higher early postnatal IGF-I levels predicted both lumbar spine bone mineral density and bone mineral content (P < 0.05). Higher early postnatal IGF binding protein-3 (P < 0.01) predicted increased fat mass at 4-y follow-up. CONCLUSION Ex-preterm children have normal bone mass but different body composition compared with full-term controls. Higher early IGF-I and late postnatal IGF-II concentrations are positive predictors of lumbar spine bone mass.
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Kamiya N, Suzuki H, Endo T, Yano M, Naoi M, Nishimi D, Kawamura K, Imamoto T, Ichikawa T. Clinical usefulness of bone markers in prostate cancer with bone metastasis. Int J Urol 2012; 19:968-79. [PMID: 22805007 DOI: 10.1111/j.1442-2042.2012.03098.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Bone metastases occur in approximately 70% of patients with advanced prostate cancer. Skeletal-related events have been correlated with reduced survival and quality of life of patients with prostate cancer. Biochemical markers of bone metabolism (e.g. bone formation, bone resorption, osteoclastogenesis) might meet an unmet need for useful, non-invasive and sensitive surrogate information for following patients' skeletal health. Recently, zoledronic acid and denosumab have been proven to have the potential for preventing skeletal-related events among prostate cancer patients with bone metastasis. An improved understanding of the mechanisms underlying bone metastasis has also led to the recognition of multiple molecular targets and advances in therapy. However, estimating the efficacy of these agents is difficult. A clinical trial for castration-resistant prostate cancer is currently underway based on the definition of The Prostate Cancer Clinical Trials Working Group, and bone turnover markers are being used as conventional end-points for the clinical trial. Bone turnover markers are useful surrogate markers reflecting the effect of new therapeutic drugs and prognosis, as well as assessment of bone metastases. In particular, N-terminal cross-linked telopeptide of type 1 collagen and bone-specific alkaline phosphatase are widely used bone metabolism markers, and offer reliable surrogate markers to detect bone metastatic spread and to predict prognosis for prostate cancer patients with bone metastases.
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Affiliation(s)
- Naoto Kamiya
- Department of Urology, Toho University Sakura Medical Center, Sakura, Japan.
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5
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Yamashita T, Okano K, Tsuruta Y, Akiba T, Nitta K. Serum osteocalcin levels are useful as a predictor of cardiovascular events in maintenance hemodialysis patients. Int Urol Nephrol 2012; 45:207-14. [DOI: 10.1007/s11255-012-0156-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Accepted: 03/03/2012] [Indexed: 12/01/2022]
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Tubić B, Magnusson P, Swolin-Eide D, Mårild S. Relation between bone mineral density, biological markers and anthropometric measures in 4-year-old children: a pilot study within the IDEFICS study. Int J Obes (Lond) 2011; 35 Suppl 1:S119-24. [PMID: 21483411 DOI: 10.1038/ijo.2011.42] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To investigate the relationship between bone mineral density (BMD), anthropometric characteristics, levels of biological markers for growth, bone turnover, insulin resistance and fat mass in 4-year-old Swedish children. METHODS Descriptive study with 41 children (28 boys) who had anthropometric measurements and blood samples taken and heel dual-energy X-ray absorptiometry and laser (DXL) performed. The study participants were divided into groups of normal-weight (n=28) and overweight or obese (n=13) children. RESULTS There was a significant difference in bone mineral content (BMC), BMD and bone mineral apparent density (BMAD) between overweight and normal-weight children. There was a significant positive correlation between BMC, BMD, BMAD and body mass index standard deviation scores (r=0.36, 0.34 and 0.29, P<0.01, respectively), waist circumference (r=0.32, 0.30, P<0.01 and r=0.26, P<0.05, respectively) and subscapular skinfold (r=0.26, 0.25 and 0.23, P<0.05, respectively). BMC and BMD correlated significantly with the sum of skinfold measures (r=0.25 and 0.23, P<0.05, respectively). Adiponectin was significantly inversely correlated with BMC, BMD and BMAD (r=-0.41, -0.40 and -0.41, P<0.01, respectively). Adiponectin was not correlated with skinfold measures. Multiple regression analysis revealed that adiponectin was an independent determinant of BMD, BMC and BMAD. CONCLUSION To our knowledge, this is the first study investigating BMD assessed by heel-DXL in relation to anthropometry and metabolic markers in 4-year-old children. Adiponectin was significantly inversely correlated with bone mass parameters. Adiponectin may have an independent role in bone development and metabolism in young children.
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Affiliation(s)
- B Tubić
- Department of Paediatrics, Institute for Clinical Sciences, The Queen Silvia Children's Hospital, The Sahlgrenska Academy at University of Gothenburg, Sweden.
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7
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Circadian rhythm of bone formation biomarkers in serum of dromedary camels. Res Vet Sci 2010; 89:455-9. [DOI: 10.1016/j.rvsc.2010.03.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2005] [Revised: 02/14/2010] [Accepted: 03/23/2010] [Indexed: 11/18/2022]
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Mejjad O, Loët XL, Basuyau JP, Ménard JF, Jego P, Grisot C, Daragon A, Grosbois B, Euller-Ziegler L, Monconduit M. Osteocalcin is not a marker of progress in multiple myeloma. Eur J Haematol 2009. [DOI: 10.1111/j.1600-0609.1996.tb00289.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Swolin-Eide D, Hansson S, Larsson L, Magnusson P. The novel bone alkaline phosphatase B1x isoform in children with kidney disease. Pediatr Nephrol 2006; 21:1723-9. [PMID: 16932897 DOI: 10.1007/s00467-006-0231-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2006] [Revised: 04/18/2006] [Accepted: 05/18/2006] [Indexed: 01/01/2023]
Abstract
The bone alkaline phosphatase (BALP) B1x isoform has previously only been identified in some adults with chronic kidney disease on dialysis and in human bone tissue. Twenty-nine patients, 3-20 years of age, with reduced renal function due to a variety of kidney diseases were examined. We measured parathyroid hormone (PTH), biointact (whole 1-84) PTH, osteoprotegerin (OPG), CrossLaps (CTX), tartrate-resistant acid phosphatase isoform 5b (TRACP 5b) type I procollagen intact amino-terminal propeptide (PINP), osteocalcin, total alkaline phosphatase (ALP), and BALP isoforms B/I, B1x, B1, and B2. Fifty percent higher levels were detected of PTH vs. biointact PTH, demonstrating non-(1-84) PTH fragments detected by the PTH assay. Increased activities were found in five, four, and three patients for total ALP, B1, and B2, respectively. Sixteen (55%) patients had increased B/I levels. B1x was identified in two (7%) patients, who had OPG levels in the higher range independently of age, glomerular filtration rate (GFR), and biointact PTH. B1x was identified prior to and after 9 days of growth hormone (GH) therapy in one patient but not after 1, 3, 6, and 12 months, however. In conclusion, our study demonstrates that the novel BALP B1x isoform is occasionally found to be present in children with kidney disease but to a lesser degree in comparison with adults with chronic kidney disease on dialysis. It is essential to perform bone histomorphometry for future investigations in order to elucidate the exact nature of circulating B1x in patients with kidney disease for accurate classification of type of renal bone disease.
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Affiliation(s)
- Diana Swolin-Eide
- Department of Pediatrics, The Queen Silvia Children's Hospital, The Sahlgrenska Academy at Göteborg University, SE-416 85, Göteborg, Sweden
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Löfman O, Magnusson P, Toss G, Larsson L. Common biochemical markers of bone turnover predict future bone loss: a 5-year follow-up study. Clin Chim Acta 2005; 356:67-75. [PMID: 15936304 DOI: 10.1016/j.cccn.2004.12.014] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2004] [Revised: 12/15/2004] [Accepted: 12/16/2004] [Indexed: 11/29/2022]
Abstract
BACKGROUND Bone mineral density (BMD) is used to follow gain or loss of bone mass but cannot detect changes within a short period of time. Biochemical markers of bone turnover may be of value for prediction of individual bone loss. METHODS We studied the relation between common inexpensive markers of bone turnover (serum alkaline phosphatase (ALP), osteocalcin (OC), urinary hydroxyproline (OHPr), and calcium (Ca)), BMD, age, and menopause in a combined cross-sectional and longitudinal design comprising 429 pre- and postmenopausal randomly selected women aged 21-79 years (mean 50 years). A follow-up was initiated after 5 years (including 192 of these women), which focused on changes in bone mass and the ability of these four common markers of bone turnover (sampled at baseline) to predict future bone loss. RESULTS A marked increase was observed for all markers at the beginning of menopause. During the postmenopausal period ALP and Ca decreased to near premenopausal levels, while OC and OHPr remained high even 15 years after menopause. We also found inverse correlations at baseline between the bone markers and BMD, independent of the selected marker or skeletal site, r=-0.14 to -0.46, P<0.05. The correlations between ALP, OC, OHPr, and subsequent bone loss over 5 years, was significant for arm, r=-0.23 to -0.36, P<0.01. Baseline levels of all bone markers correlated significantly at group level with the 5-year follow-up of BMD for all sites. The ability of markers to predict individual bone loss was estimated by a multivariate regression model, which included baseline BMD, age, and body mass index as independent variables. ROC analysis showed a validity of approximately 76% for the forearm model, but was lower for the hip (55%) and lumbar spine (65%). CONCLUSIONS These data show that the common inexpensive biochemical markers of bone turnover ALP, OC, OHPr, and Ca were related to the current bone mass and, moreover, provides information about future bone loss at the individual level. Future investigations should include an evaluation of the clinical relevance of markers of bone turnover in relation to fracture risk.
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Affiliation(s)
- Owe Löfman
- Center for Public Health Sciences, Department of Health and Environment, Linköping University Hospital, SE-581 85 Linköping, Sweden
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Chailurkit LO, Suthutvoravut U, Mahachoklertwattana P, Charoenkiatkul S, Rajatanavin R. Biochemical markers of bone formation in Thai children and adolescents. Endocr Res 2005; 31:159-69. [PMID: 16392618 DOI: 10.1080/07435800500371607] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The measurement of biochemical markers of bone turnover is essential in the study of skeletal metabolism in health and diseases. Due to variations in the rate of bone growth in different age groups and possible ethnic differences, age-specific reference ranges for biochemical markers should be established in a particular pediatric population. In this study, biochemical markers of bone formation, bone-specific alkaline phosphatase (BAP), and osteocalcin (OC) in healthy Thai children and adolescents aged 9 to 18 years were evaluated in relation to their ages and pubertal development. Serum BAP levels in boys increased with age and peaked at about 12 to 13 years. In contrast, there was a progressive decline of serum BAP levels with advancing age in girls older than 9 years. Serum OC also increased with age and reached a peak at ages 12 and 13 years in girls and boys, respectively. In addition, both serum BAP and OC levels also varied with pubertal stages. The BAP levels in boys increased sharply at pubertal stage 3 and decreased at pubertal stage 5. In girls, the BAP levels showed a fairly constant high level up to stage 3, followed by a remarkable decrease thereafter. The OC levels in boys increased sharply at pubertal stage 4 and decreased thereafter. In girls, OC started to increase at pubertal stage 3 with no subsequent changes. The levels of serum BAP and OC were higher in boys than in girls at pubertal stages 3 to 5 and at stages 2, 4, and 5, respectively. Moreover, only serum BAP level showed significant positive correlation with height velocity in both genders. In multiple regression analyses, gender, age, and pubertal stage were consistently correlated with both serum BAP and OC levels. In summary, male and female adolescents have different patterns of changes in biochemical markers of bone formation.
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Affiliation(s)
- La-or Chailurkit
- Division of Endocrinology and Metabolism, Department of Medicine, Ramathibodi Hospital, Mahidol University, Rama 6th Road, Bangkok, 10400, Thailand.
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Abstract
Osteoporosis is a skeletal disease in which there is a loss of, or de-crease in, bone mass with a deterioration of the microarchitecture of bone tissue. The disease is progressive, taking place over a period of years, and involves derangements in the processes of bone turnover. These derangements can be classified as those in which osteoclast activity (resorption) is stimulated so that more bone is re-moved than formed or in which osteoblast activity (formation) is hindered such that refilling of the resorption cavity is incomplete. Regardless of the process, a key pathologic development is the net loss of bone mass. This article reviews the use of biochemical markers in osteoporosis.
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Affiliation(s)
- Catherine A Hammett-Stabler
- Department of Pathology and Laboratory Medicine, Campus box 7525, University of North Carolina, Chapel Hill, NC 27599, USA.
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Ivaska KK, Hellman J, Likojärvi J, Käkönen SM, Gerdhem P, Akesson K, Obrant KJ, Pettersson K, Väänänen HK. Identification of novel proteolytic forms of osteocalcin in human urine. Biochem Biophys Res Commun 2003; 306:973-80. [PMID: 12821138 DOI: 10.1016/s0006-291x(03)01093-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
In this study, we report the isolation and characterization of osteocalcin in human urine using mass spectrometry and N-terminal sequencing. Multiple proteolytic forms of osteocalcin were found, which consisted of 16-27 residues from the middle region of the molecule. Several fragments had residue Gly7 at the N-terminus and the most predominant was fragment 7-31. Additional fragments starting from residue Asp14 were detected in the samples of children and young adults. Immunochemical detection of urine osteocalcin fragments had a statistically significant negative correlation to bone mineral density in evaluation of urine samples from 75-year-old women. Thus, the measurement of osteocalcin fragments in urine may have potential applications in diagnostics related to disorders of bone metabolism.
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Affiliation(s)
- Kaisa K Ivaska
- Department of Anatomy, Institute of Biomedicine, University of Turku, Kiinamyllynkatu 10, FIN-20520, Turku, Finland.
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Dubois EFL, Derks MGM, Zwinderman AH, Dekhuijzen PNR, Van Boxtel CJ, Schweitzer DH. Distinct actions of prednisolone and dexamethasone towards osteocalcin and eosinophilic cationic protein in assumed clinically equivalent doses: a study in healthy men. Eur J Clin Pharmacol 2003; 58:733-7. [PMID: 12634979 DOI: 10.1007/s00228-002-0549-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2002] [Accepted: 11/27/2002] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To study the effects of prednisolone (PRED) and dexamethasone (DEXA) in assumed clinically equivalent doses towards the lowering of cortisol, osteocalcin (OC) and the stimulated rise of eosinophilic cationic protein (ECP) by granulocyte colony stimulating factor (G-CSF). METHODS At four separate sessions of 25 h each, saline i.v. alone, G-CSF s.c. alone or in combination with either 12.5 mg PRED i.v. or 2.0 mg DEXA i.v., were randomly administered in eight healthy male subjects. RESULTS All subjects had equal lowering of cortisol after DEXA and PRED at 10 h, whereas a sustained suppression at 25 h persisted only after administration of DEXA. Between 4 h and 10 h after administration of DEXA and PRED, the change in the area under the concentration-time curve (DeltaAUC4-10) of OC became 24.4% and 2.3% lower, respectively ( p<0.0001). After 25 h, this effect persisted for DEXA. DeltaAUC4-10 of the G-CSF-stimulated ECP response decreased by a mean of 76.8% after PRED compared with DEXA and to controls ( p<0.02), and this difference had disappeared at 25 h. DEXA did not elicit any effect towards the G-CSF-stimulated ECP response. CONCLUSION PRED and DEXA in formerly assumed clinically equivalent doses induced a similar suppression towards cortisol within the first 10 h, but had different actions towards blood concentrations of OC and ECP following G-CSF stimulation in healthy male subjects.
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Affiliation(s)
- E F L Dubois
- Department of Pulmonary Diseases, Reinier de Graaf Groep, Fonteyenburghlaan 5, 2275 CX Voorburg, Delft-Voorburg, The Netherlands.
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Schoenau E, Rauch F. Biochemical Measurements of Bone Metabolism in Childhood and Adolescence/Biochemische Messungen des Knochenstoffwechsels in Kindheit und Adoleszenz. ACTA ACUST UNITED AC 2003. [DOI: 10.1515/labmed.2003.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Takahashi M, Naitou K, Ohishi T, Nagano A. Comparison of biochemical markers of bone turnover and bone mineral density between hip fracture and vertebral fracture. J Clin Densitom 2003; 6:211-8. [PMID: 14514989 DOI: 10.1385/jcd:6:3:211] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2002] [Accepted: 10/14/2002] [Indexed: 11/11/2022]
Abstract
Bone density and the biochemical markers of bone turnover were compared between 26 hip-fracture patients and 41 vertebral-fracture patients after age adjustment to investigate whether or not type of osteoporosis differs between hip fracture and vertebral fracture. C-Terminal propepides of type I collagen (PIPC) was lower in hip fracture than vertebral fracture. The other bone formation markers (bone-specific alkaline phosphatase [ALP], osteocalcin) tended to be lower, and bone resorption markers (deoxypyridinoline, C-telopeptide crosslinking of type I collagen [CTX] tended to be higher in hip fracture compared to vertebral fracture. Mean of Z-scores of spine bone mineral density (BMD) in hip fracture and vertebral fracture were -0.461 and -0.919, respectively. Mean of Z-scores of femoral neck BMD in hip fracture and vertebral fracture were -0.994 and -0.361, respectively. All Z-scores were negative values, which means reduction of BMD compared to decade-matched controls. Z-scores of bone formation markers, such as bone-specific ALP, osteocalcin, and PIPC, were positive values in vertebral fracture, which means an increase against decade-matched controls, whereas those were negative values in hip fracture. Z-scores of bone resorption markers, such as deoxypyridinoline and CTX, were greater in hip fracture than in vertebral fracture. To express bone balance between formation and resorption in hip fracture and vertebral fracture, we calculated an uncoupling status index (USI) by the values of biochemical markers. USI of hip fracture showed a great negative value (-1.29), which indicates excess of bone resorption over formation, whereas that of vertebral fracture showed a small positive value (0.23). In conclusion, bone formation markers increase in vertebral fractures, but decrease in hip fracture. Bone resorption markers increase in both fracture, but greater increase in hip fracture.
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Affiliation(s)
- Masaaki Takahashi
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, 431-3192, Japan.
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Abstract
BACKGROUND Osteoporosis in many countries has reached epidemic proportions. This has stimulated the development of biochemical markers to assist in the assessment of osteoporotic risk and in monitoring the efficacy of treatment. Biochemical markers of bone turnover are products released from osteoblasts and osteoclasts or collagen breakdown products. MARKERS Markers of bone formation include bone-specific alkaline phosphatase (BAP), osteocalcin (OC) and procollagen peptides. All of these can be measured easily by immunoassay techniques. Of these markers, OC has been extensively studied. However, OC undergoes in vitro degradation, thus, assay results are variable. BAP, on the other hand, is much more stable and shows less within-person biological variation. Bone resorption markers include tartrate-resistant acid phosphatase (TRAP) and collagen breakdown products, such as pyridinium cross-links, galactosyl hydroxylysine and cross-linked telopeptides, such as CTx and NTx. Of these, deoxypyridinium (DPD) has been extensively studied. DPD shows diurnal variation and the within-individual biological variation is large. Of the newer assays, NTx appear to show large differences at menopause. CONCLUSIONS Thus, serum BAP and DPD or NTx are the current choice of bone markers.
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Affiliation(s)
- R Swaminathan
- Department of Chemical Pathology, Guy's, King's and St. Thomas' School of Medicine, St. Thomas' Campus, Lambeth Palace Road, SE1 7EH, London, UK.
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Magnusson P, Sharp CA, Magnusson M, Risteli J, Davie MW, Larsson L. Effect of chronic renal failure on bone turnover and bone alkaline phosphatase isoforms. Kidney Int 2001; 60:257-65. [PMID: 11422759 DOI: 10.1046/j.1523-1755.2001.00794.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Biochemical markers of bone turnover are used to monitor metabolic bone disease associated with renal failure. We have applied a comprehensive panel of markers to patients with chronic renal failure (CRF), with particular focus on the isoforms of bone alkaline phosphatase (BALP). METHODS Twenty CRF patients undergoing hemodialysis (N = 9) and peritoneal dialysis (N = 11) were measured for serum parathyroid hormone (PTH), osteocalcin, total ALP, and four BALP isoforms (B/I, B1x, B1, and B2) by high-performance liquid chromatography. These BALP isoforms were also compared with BALP measured by three commercial immunoassays (Alkphase-B, Tandem-R Ostase, and Tandem-MP Ostase). Type I collagen turnover was assessed by serum samples using the type I procollagen intact amino- and carboxy-terminal propeptides (PINP and PICP) and two fragments (ICTP and CrossLaps) derived from the carboxy-terminal telopeptide of mature matrix collagen by different degradative pathways. RESULTS Mean levels of bone turnover markers were elevated in CRF, with marked increases in those markers, osteocalcin, ICTP, and CrossLaps, cleared by the kidney. Total ALP activities were increased corresponding to elevated B/I and B2 isoform levels. The B1 isoform level was not significantly different from healthy controls. B1x was detected in 60% of the patients but was not resolved in healthy individuals. Kendall's tau rank correlation showed that B1x correlated significantly (P < 0.05) with B1 (0.53) and PINP (0.55), and was the only marker to correlate with PTH (0.49). B1x was not significantly correlated with any of the commercial BALP immunoassays. Interestingly, the immunoassay calibrators contained high activities of the B/I peak (39 to 80%) compared with human serum (4%). CONCLUSION There are selective differences between the BALP isoforms in CRF compared with healthy adults. The commercial BALP immunoassays are comparable with each other but are unable to distinguish the BALP isoform-specific differences in CRF patients.
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Affiliation(s)
- P Magnusson
- Bone and Mineral Metabolic Unit, Division of Clinical Chemistry, Department of Biomedicine and Surgery, Linköping University Hospital, Linköping, Sweden.
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Chailurkit LO, Ongphiphadhanakul B, Piaseu N, Saetung S, Rajatanavin R. Biochemical Markers of Bone Turnover and Response of Bone Mineral Density to Intervention in Early Postmenopausal Women: An Experience in a Clinical Laboratory. Clin Chem 2001. [DOI: 10.1093/clinchem/47.6.1083] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
AbstractBackground: Markers of bone formation and resorption may be useful as early indicators of response to therapy. Our aim in this study was to investigate the use of bone markers for monitoring of intervention for bone loss in early postmenopausal women and to assess the relationships between these markers and changes in bone mineral density (BMD).Methods: Subjects were randomly assigned to the following groups: a control group; a group receiving calcium alone; groups receiving calcium plus low or conventional doses of conjugated equine estrogen; and groups receiving calcium plus low or conventional doses of calcitriol. At baseline and at 1 and 3 months after intervention, we measured serum intact osteocalcin, serum N-terminal midfragment osteocalcin, serum C-terminal telopeptide of type I collagen (CTx), urinary deoxypyridinoline cross-links, and urinary CTx. The BMD of the lumbar spine and the femoral neck was measured at baseline and after 1 and 2 years of intervention.Results: No marker changed significantly in the control group except urinary CTx, which increased at 3 months. Serum CTx decreased in all regimens at 1 or 3 months of intervention. In addition, the changes of all markers at 3 months were inversely associated with the change in the BMD of the lumbar spine at 1 or 2 years (r = −0.144 to −0.314), whereas only the changes of bone resorption markers at 3 months were inversely correlated with the changes in femoral BMD at 1 or 2 years (r = −0.143 to −0.366).Conclusions: Biochemical markers of bone turnover appear to be of use in assessing early response to therapy. Bone resorption markers, especially serum CTx, are better indicators than bone formation markers for estimating the response to intervention in early postmenopausal women. However, the early changes in bone markers were weakly related to the later changes in BMD.
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Affiliation(s)
- La-or Chailurkit
- Division of Endocrinology and Metabolism, Department of Medicine, Ramathibodi Hopital, Mahidol University, Rama VI Road, Bangkok 10400, Thailand
| | - Boonsong Ongphiphadhanakul
- Division of Endocrinology and Metabolism, Department of Medicine, Ramathibodi Hopital, Mahidol University, Rama VI Road, Bangkok 10400, Thailand
| | - Noppawan Piaseu
- Division of Endocrinology and Metabolism, Department of Medicine, Ramathibodi Hopital, Mahidol University, Rama VI Road, Bangkok 10400, Thailand
| | - Sunee Saetung
- Division of Endocrinology and Metabolism, Department of Medicine, Ramathibodi Hopital, Mahidol University, Rama VI Road, Bangkok 10400, Thailand
| | - Rajata Rajatanavin
- Division of Endocrinology and Metabolism, Department of Medicine, Ramathibodi Hopital, Mahidol University, Rama VI Road, Bangkok 10400, Thailand
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Affiliation(s)
- V Palicka
- Charles University, University Hospital, Institute of Clinical Biochemistry and Diagnostics, Hradec Kralove, Czech Republic
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21
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Takahashi M, Naitou K, Ohishi T, Kushida K, Miura M. Effect of vitamin K and/or D on undercarboxylated and intact osteocalcin in osteoporotic patients with vertebral or hip fractures. Clin Endocrinol (Oxf) 2001; 54:219-24. [PMID: 11207637 DOI: 10.1046/j.1365-2265.2001.01212.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To examine serum undercarboxylated osteocalcin (OC) with application of an ELISA in normal women and in osteoporotic patients with vertebral fractures or hip fractures, and to investigate the effects of vitamin K and/or D treatment on undercarboxylated OC and intact OC in vertebral fractures. PATIENTS They were 43 premenopausal (PRE) and 48 postmenopausal healthy females (POST), 89 osteoporotic patients with vertebral fractures (VX) and, 24 patients with hip fracture (HX). MEASUREMENTS Intact OC was measured by an IRMA and undercarboxylated OC was measured by an ELISA. RESULTS Intact osteocalcin was significantly higher in POST and VX than in PRE, and was significantly lower in HX than in POST and VX. Undercarboxylated OC tended to be higher in POST, VX and HX than in PRE, but not significantly. The ratio of undercarboxylated OC to intact OC was significantly higher in HX than in POST and in VX. After 4 weeks treatment with K, D, and K + D to 56 VX, undercarboxylated OC decreased significantly in the groups with K and K + D. Intact OC tended to increase slightly in the groups given K, D, K + D, but not significantly so. Vitamin K and vitamin K + D markedly decreased the ratio of undercarboxylated/intact OC to approximately 80%. On the other hand, vitamin D did not decrease that ratio. CONCLUSIONS There was a disproportion of undercarboxylated osteocalcin to intact osteocalcin between postmenopausal women and osteoporotic patients with vertebral fractures or hip fractures. Vitamin K did decrease undercarboxylated osteocalcin, vitamin D did not change undercarboxylated osteocalcin, and vitamin D did not enhance the effect of vitamin K on undercarboxylated osteocalcin.
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Affiliation(s)
- M Takahashi
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.
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22
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Luukinen H, Käkönen SM, Pettersson K, Koski K, Laippala P, Lövgren T, Kivelä SL, Väänänen HK. Strong prediction of fractures among older adults by the ratio of carboxylated to total serum osteocalcin. J Bone Miner Res 2000; 15:2473-8. [PMID: 11127212 DOI: 10.1359/jbmr.2000.15.12.2473] [Citation(s) in RCA: 141] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
We examined serum total osteocalcin (TOC), carboxylated osteocalcin (COC), and their ratio (COC/TOC) by one-step two-site immunofluorescent assays in 87% (n = 792) of all home-dwelling persons of 70 years or older living in a defined area in northern Finland. Other baseline subject-related risk factors of fractures were assessed by postal questionnaires, interviews, clinical examinations, and tests. During a 5-year follow-up period, all falls and fractures (n = 106) were recorded by regular phone calls and by examining all the medical records yearly. Serum TOC and COC concentrations increased with advancing age and were higher in women than in men, but corresponding differences were not found in the case of COC/TOC. The adjusted relative risk of fracture was elevated in association with low (< or =-1 SD from the mean) COC; hazard ratio (HR, 95% CI) 2.00 (1.20-3.36) and low COC/TOC; HR 5.32 (3.26-8.68), the relative risk being highest in the population older than 80 years; and HR 7.02 (2.42-20.39). The predictive value of low COC/TOC lasted 3 years. The multivariable-adjusted relative risk of hip fracture (n = 26) in regard to low COC/TOC ratio was 3.49 (1.12-10.86), as compared with the persons who did not suffer hip fractures. Our results suggest that serum COC concentrations and, more strongly, COC/TOC, predict the occurrence of fractures in older community-dwelling adults. The risk of fracture associated with low COC/TOC equals the hip fracture risk previously verified for concomitant high serum undercarboxylated OC concentrations and low bone mineral density.
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Affiliation(s)
- H Luukinen
- Department of Public Health Science and General Practice, University of Oulu, Oulu University Hospital, Finland
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23
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Affiliation(s)
- A J Lee
- Division of Clinical Sciences (NGHT), University of Sheffield, Northern General Hospital, UK
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Takahashi M, Kushida K, Nagano A, Inoue T. Comparison of the analytical and clinical performance characteristics of an N-MID versus an intact osteocalcin immunoradiometric assay. Clin Chim Acta 2000; 294:67-76. [PMID: 10727674 DOI: 10.1016/s0009-8981(99)00251-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Osteocalcin is the most abundant non-collagenous protein in bone, reflecting its formation. It was reported that the instability of intact osteocalcin results from the cleavage of the C-terminal sequence of osteocalcin to produce a large N-terminal osteocalcin fragment. A two-site immunoassay for detecting both the N-terminal osteocalcin fragment and the intact osteocalcin was developed that were both independent of an unstable C-terminal sequence. The aim of this study is to investigate the performance of an N-MID osteocalcin immunoradiometric assay and to compare it with an intact osteocalcin assay. Ten serum samples were repeatedly frozen and thawed up to seven times. The variability of the values of N-MID osteocalcin was less than that of the intact osteocalcin. For stability of osteocalcin in serum after storage, the mean value of N-MID was 94. 3% of the initial value after 7 days at 4 degrees C, whereas the intact was 73.4%. The reduction of intact values were significantly larger than that of N-MID after 2, 5 and 7 days. At -30 degrees C, the values of N-MID did not change for up to 10 weeks. The concentrations of osteocalcin measured by an N-MID osteocalcin and an intact osteocalcin were investigated in 27 premenopausal subjects, 27 postmenopausal subjects, and 68 osteoporotic patients (23 with vertebral fractures and 45 with hip fractures). The percent mean increase of osteocalcin in postmenopausal subjects over premenopausal subjects was 98% in N-MID versus 42% in the intact assay. The z-scores of N-MID and intact showed similar results in all groups. N-MID osteocalcin significantly correlated with intact osteocalcin (r=0.755), and other biochemical markers for bone formation, such as bone specific alkaline phosphatase (r=0.606) and C-terminal propeptide of type I procollagen (PICP) (r=0.568). An N-MID IRMA had better stability during storage than intact and had the discriminative ability which is similar to the intact assay in postmenopause and osteoporosis. Therefore, an N-MID osteocalcin IRMA could improve the clinical utility and evaluation of osteocalcin.
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Affiliation(s)
- M Takahashi
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 3600 Handa, Hamamatsu, Japan.
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25
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Käkönen SM, Hellman J, Karp M, Laaksonen P, Obrant KJ, Väänänen HK, Lövgren T, Pettersson K. Development and Evaluation of Three Immunofluorometric Assays That Measure Different Forms of Osteocalcin in Serum. Clin Chem 2000. [DOI: 10.1093/clinchem/46.3.332] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
AbstractBackground: Circulating human osteocalcin (hOC) has been used as a marker of bone formation. Our aim was to validate three immunofluorometric assays (IFMAs), measuring different forms of hOC.Methods: The two-site IFMAs were based on previously characterized monoclonal antibodies. Assay 2 recognized intact hOC, assays 4 and 9 measured the NH2-terminal mid-fragment and the intact hOC. In addition, assay 9 required hOC to be γ-carboxylated.Results: A 76–79% increase of serum immunoreactive hOC was found in the postmenopausal group compared with the premenopausal group with all IFMAs. With EDTA-plasma samples, the observed increases were lower (49–65%). The hOC concentration in the postmenopausal group receiving hormone replacement therapy was 42–44% lower than that in the postmenopausal control group in both serum and EDTA-plasma samples. The depressed carboxylation in warfarin-treated patients was accompanied by lower results in assay 9. The ratio of assay 9 to assay 4 totally discriminated the warfarin-treated patients from the controls. Assay 9 showed the smallest decreases in measured hOC after storage of serum or plasma for 4 weeks at 4 °C, followed by assay 4 and assay 2. Results from the last assay were <17% of their initial values after 4 weeks of storage. No diurnal variation was observed with assay 9 as opposed to the two other IFMAs.Conclusion: The three assays with their distinct specificity profiles (intact vs fragmented and carboxylated vs decarboxylated hOC) may provide valuable tools for investigating the significance of different hOC forms in various bone-related diseases.
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Affiliation(s)
| | - Jukka Hellman
- Centre for Biotechnology, University of Turku and Åbo Akademi University, FIN-20520 Turku, Finland
| | - Matti Karp
- Department of Biotechnology, University of Turku, FIN-20520 Turku, Finland
| | - Pirjo Laaksonen
- Department of Biotechnology, University of Turku, FIN-20520 Turku, Finland
| | - Karl J Obrant
- Department of Orthopaedics, Malmö University Hospital, S-20502 Malmö, Sweden
| | - H Kalervo Väänänen
- Institute of Biomedicine, Department of Anatomy, University of Turku, FIN-20520 Turku, Finland
| | - Timo Lövgren
- Department of Biotechnology, University of Turku, FIN-20520 Turku, Finland
| | - Kim Pettersson
- Department of Biotechnology, University of Turku, FIN-20520 Turku, Finland
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Abstract
Abstract
Remodeling is essential for bone health. It begins with resorption of old bone by osteoclasts, followed by the formation of new bone by osteoblasts. Remodeling is coupled (formation is linked to resorption). After middle age or perhaps beginning earlier, bone loss occurs because resorption exceeds formation. This imbalance is accentuated by estrogen deficiency as well as by many diseases and conditions. Biochemical markers that reflect remodeling and can be measured in blood or urine include resorption markers (e.g., collagen cross-links) and formation markers (e.g., alkaline phosphatase).
Bone markers exhibit substantial short-term and long-term fluctuations related to time of day, phase of the menstrual cycle, and season of the year, as well as diet, exercise, and anything else that alters bone remodeling. These biological factors, in addition to assay imprecision, produce significant intra- and interindividual variability in markers.
Bone marker measurements are noninvasive, inexpensive, and can be repeated often. Unfortunately, most of the studies that provided insight on clinical situations did not focus on markers as a primary endpoint. Bone markers have been useful in clinical practice and have been helpful in understanding the pathogenesis of osteoporosis and the mechanism of action of therapies. In clinical trials, markers aid in selecting optimal dose and in understanding the time course of onset and resolution of treatment effect. Clinical questions that might be answered by bone markers include diagnosing osteoporosis, identifying “fast bone losers” and patients at high risk of fracture, selecting the best treatment for osteoporosis, and providing an early indication of the response to treatment. Additional information is needed to define specific situations and cut points to allow marker results to be used with confidence in making decisions about individual patients.
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Takahashi M, Kushida K, Hoshino H, Ohishi T, Inoue T. Biochemical markers of bone turnover do not decline after menopause in healthy women. BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1999; 106:427-31. [PMID: 10430192 DOI: 10.1111/j.1471-0528.1999.tb08295.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To investigate the duration of high bone turnover after menopause in normal healthy women. DESIGN Study recruited from three screening studies for health care in the elderly held in the area of Hamamatsu city. SETTING Department of Orthopaedic Surgery, Hospital at Hamamatsu University School of Medicine, Hamamatsu. PARTICIPANTS Ninety-two healthy postmenopausal women aged 47-81 years and 18 premenopausal women. MAIN OUTCOME MEASURES Bone mass was determined by densitometry of the spine and the os calcis, or by ultrasound of the os calcis. Biochemical markers of bone turnover were measured including total and bone-specific alkaline phosphatase, osteocalcin, C-terminal propeptide of type I procollagen, free deoxypyridinoline and urinary degredation products of type I collagen. RESULTS All markers except the C-terminal propeptide of type I procollagen were significantly higher in early postmenopausal women than in premenopausal women. Postmenopausal women were divided into four groups according to years since menopause. There was no difference in biochemical markers among those women in whom years since menopause were 1 to 5, 6 to 15, 16 to 25 and >26. There were no correlations between biochemical markers and age in postmenopausal women. When the postmenopausal women were divided into three groups according to t-scores of bone mass, there was no significant difference in the biochemical markers among the groups. CONCLUSIONS High bone turnover occuring after menopause lasts for >25 years during the postmenopausal period.
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Affiliation(s)
- M Takahashi
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Handa, Japan
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28
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Matikainen T, Käkönen SM, Pettersson K, Karp M, Lövgren T, Väänänen HK, Hellman J. Demonstration of the predominant urine osteocalcin fragments detectable by two-site immunoassays. J Bone Miner Res 1999; 14:431-8. [PMID: 10027908 DOI: 10.1359/jbmr.1999.14.3.431] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We have isolated and characterized human osteocalcin (OC) fragments from pubertal urine. The fragments were isolated by immunoaffinity chromatography based on monoclonal antibody 6F9 and further purified by reverse phase chromatography. The major isolated forms, which were detectable with two-site immunofluorometric assays for serum OC, span residues 6-30 and 7-30 as determined by mass spectrometry and N-terminal amino acid sequencing. Full-length OC was not detectable in the supernatant fraction of urine but could be extracted with guanidinium hydrochloride from the sediment of urine samples. Urine samples from subjects with different menopausal status were measured by two different two-site assays. Urine OC (uOC) concentrations were 12- to 16-fold higher in the pubertal group than in the adult group. Also, the uOC concentration in a postmenopausal group was significantly higher than in a premenopausal group. The difference was 125% and 75% (values for p < 0.0001), respectively, when measured with the two assays. uOC concentrations in postmenopausal subjects on hormone replacement therapy were indistinguishable from the premenopausal subjects. The fact that uOC can be measured by a noncompetetive two-site assay design offers improved analytical sensitivity. Urine as the sample matrix is also especially interesting because the predominant markers of bone resorption, collagen type I peptides or cross-links, are performed on urine samples. Our results from the technical validation of two-site assays for uOC and from applying these to human pubertal and pre- and postmenopausal samples calls for more extensive clinical validation.
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Affiliation(s)
- T Matikainen
- Department of Anatomy, University of Turku, Turku, Finland
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29
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Miller PD, Baran DT, Bilezikian JP, Greenspan SL, Lindsay R, Riggs BL, Watts NB. Practical clinical application of biochemical markers of bone turnover: Consensus of an expert panel. J Clin Densitom 1999; 2:323-42. [PMID: 10548827 DOI: 10.1385/jcd:2:3:323] [Citation(s) in RCA: 95] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/1999] [Revised: 04/26/1999] [Accepted: 05/03/1999] [Indexed: 11/11/2022]
Abstract
Biochemical markers of bone turnover have emerged as powerful tools to aid in managing osteoporosis. The newer bone markers have been intensively studied for more than a decade. As a result, we can now confidently report their clinical utility in assessing risk of rapid bone loss and fracture, and monitoring therapy in postmenopausal women with or at risk of osteoporosis. In this review, we will provide a comprehensive foundation for this utility. While there are still questions remaining to be answered, bone marker technology has matured to play an essential role in patient management. We will describe, in practical terms, how bone markers can be appropriately incorporated into clinical practice today.
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Affiliation(s)
- P D Miller
- Department of Medicine, University of Colorado Health Sciences Center and Colorado Center for Bone Research, Denver, CO 80227, USA.
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Seibel MJ, Woitge HW. Basic principles and clinical applications of biochemical markers of bone metabolism: biochemical and technical aspects. J Clin Densitom 1999; 2:299-321. [PMID: 10548826 DOI: 10.1385/jcd:2:3:299] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/1999] [Revised: 04/23/1999] [Accepted: 04/26/1999] [Indexed: 01/12/2023]
Abstract
The interest in and the need for effective measures to be used in the screening, diagnosis, and follow-up of disorders of connective tissue, bone, and mineral metabolism has markedly grown. Next to clinical and imaging techniques, indices of bone turnover have come to play an important role in the assessment of metabolic bone disease. In osteoporosis, recent research has shown that bone markers may also be used to predict future bone loss and hip fractures (in larger cohorts of older patients), identify individuals at risk for osteoporosis, select therapy, and predict and monitor the therapeutic response in individual patients. The development of new markers of bone metabolism has greatly enriched the spectrum of serum and urine analytes used in the assessment of skeletal pathologies. Besides total alkaline phosphatase, other markers such as bone-specific alkaline phosphatase, osteocalcin, or the collagen propeptides are being used to measure bone formation. Bone resorption, previously assessed only by the measurement of urinary calcium and hydroxyproline, may now be detected more precisely by a number of new serum and urine markers. Among these, the pyridinium crosslinks and the telopeptides of collagen type I are presently considered the most specific markers of bone resorption. More recently, bone sialoprotein has also been suggested as a marker of bone resorption in serum. Tartrate-resistant acid phosphatase is now measurable by immunoassay. This article surveys the biochemistry and relevant technical aspects of the currently available markers of bone metabolism.
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Affiliation(s)
- M J Seibel
- Department of Internal Medicine I, Division of Endocrinology and Metabolism, University of Heidelberg, 69115 Heidelberg, Germany.
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Wolthers OD, Heuck C. Differential effects of inhaled budesonide on serum osteocalcin in children and adolescents with asthma. Pediatr Allergy Immunol 1998; 9:150-5. [PMID: 9814730 DOI: 10.1111/j.1399-3038.1998.tb00362.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In recent years, measurement of serum osteocalcin has been introduced for assessment of bone turnover in patients treated with exogenous glucocorticoids. Studies in children with asthma on inhaled glucocorticoids, however, have shown inconsistent results. The aim of the present study is to assess bone turnover in prepubertal children and in adolescents with asthma treated with inhaled budesonide using three different osteocalcin assays: the Pharmacia Osteocalcin CAP FEIA, the CIS OSTK-PR and CIS IRMA ELSA-OSTEO assays. Two studies were conducted: 1) a randomised double blind two-period crossover study of 22 prepubertal children aged 5-12 years. In one period 800 microg budesonide was given once in the morning, in the other 400 microg was given twice daily; 2) a randomised double blind placebo controlled two period crossover study of inhaled budesonide 400 microg twice daily in fourteen 13-16 year old adolescents with pubertal stages II-V. In both studies, treatment periods were of four weeks duration, and blood samples were collected at the last day of each period. In the prepubertal children none of the osteocalcin assays detected any statistically significant differences between any of the periods. In the adolescent group reduced levels of osteocalcin were seen during budesonide treatment. The suppression reached statistical significance with the CAP FEIA (P = 0.03) and the OSTK-PR (P = 0.01) assays, but not with the ELSA-OSTEO assay (P = 0.06). Correlation analyses showed statistically significant correlation coefficients varying between 0.58 and 0.91 (P = 0.03 and P < 0.0001, respectively). The effect of inhaled glucocorticoids on serum osteocalcin may depend on the assay applied, and inhaled glucocorticoids have differential effects in children and adolescents.
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Affiliation(s)
- O D Wolthers
- Department of Paediatrics, Aarhus University Hospital, Denmark
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Ylikoski A, Hellman J, Matikainen T, Käkönen SM, Karp M, Väänänen HK, Lövgren T, Pettersson K. A dual-label immunofluorometric assay for human osteocalcin. J Bone Miner Res 1998; 13:1183-90. [PMID: 9661083 DOI: 10.1359/jbmr.1998.13.7.1183] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Circulating human osteocalcin (hOC) has been shown to be comprised of two main forms: the intact 1-49 form and the proteolytic N-terminal midfragment (N-mid) spanning amino acid residues 1-43 or 1-44. We used three monoclonal antibodies (MAbs) raised against hOC and bovine osteocalcin in developing a dual-label assay for the simultaneous measurement of the proportions of the intact and N-mid forms in serum samples. The assay is based on time-resolved fluorescence utilizing differently labeled trace MAbs. Biotinylated MAb 2H9 is used as a capture antibody for both the intact hOC and the N-mid. Tracer MAb 6F9 labeled with a Europium (III)-chelate binds to the intact the N-mid and the intact hOC, whereas tracer MAb 3G8 labeled with a Terbium (III)-chelate binds to the intact hOC only. The simultaneous binding of the antibodies was tested by comparing full-length hOC purified from human bone and hOC shortened from the C terminus by four amino acid residues with carboxypeptidase Y. Serum hOC measurements with the dual-label assay were in agreement with the corresponding single-label assays (r = 0.96 for intact + N-mid assay and r = 0.81 for intact assays, n = 91). The lower correlation between the intact assays was attributable to proteolytic susceptibility of the intact form due to one additional freezing and thawing cycle in carrying out the dual-label assay. As measured with the dual-label assay, the levels (mean +/- SD) of serum intact + N-mid OC were 6.2 +/- 2.1 ng/ml in the premenopausal group (n = 44), 13.9 +/- 4.9 ng/ml in the postmenopausal group without hormone replacement therapy (HRT; n = 13), and 7.5 +/- 3.4 ng/ml in the postmenopausal group with HRT (n = 13). The levels of intact hOC in the same groups were 4.8 +/- 1.4 ng/ml, 9.8 +/- 2.9 ng/ml, and 5.3 +/- 2.1 ng/ml, respectively. Whether the main forms of OC or their relative proportions in serum can be used for predicting bone diseases or for monitoring the progression and management of diseases awaits further investigations.
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Affiliation(s)
- A Ylikoski
- Department of Biotechnology, University of Turku, Finland
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Hoshino H, Kushida K, Takahashi M, Kawana K, Denda M, Yamazaki K, Inoue T. Characteristics of biochemical markers in patients with metabolic bone disorders. Endocr Res 1998; 24:55-64. [PMID: 9553754 DOI: 10.3109/07435809809031868] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Biochemical markers of bone turnover are expected to have some different characteristics among bone metabolic disorders. We compared bone formation markers: serum total alkaline phosphatase (s-Alp), serum osteocalcin (s-OC) and serum carboxy-terminal propeptide of type I collagen (s-PICP); and bone resorption markers: serum carboxy-terminal telopeptide of type I collagen (s-ICTP), urinary pyridinoline (u-Pyr) and urinary deoxypyridinoline (u-Dpyr) to examine which marker is the most suitable and reliable to evaluate bone turnover in patients with osteoporosis (n = 29), osteomalacia (n = 10), primary hyperparathyroidism (n = 6) and renal osteodystrophy (n = 21). The value of s-Alp in the osteomalacia group was significantly higher than those in the normal control group and the osteoporosis group (p < 0.001), and T-score of s-Alp was significantly higher than those of s-OC and s-PICP in the osteomalacia group. The values of u-Pyr and u-Dpyr in the primary hyperparathyroidism group were significantly higher than those in the other groups (p < 0.001). S-PICP, which are not dependent upon renal function, was much higher in the renal osteodystrophy group than in all other groups. In the osteoporosis group, T-score of s-ICTP was significantly higher than those of s-OC. Thus, s-Alp was a good marker in osteomalacia, u-Pyr and u-Dpyr in primary hyperparathyroidism, s-PICP in renal osteodystrophy, and s-ICTP in osteoporosis.
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Affiliation(s)
- H Hoshino
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Japan
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Dominguez Cabrera C, Sosa Henríquez M, Traba ML, Alvarez Villafañe E, de la Piedra C. Biochemical markers of bone formation in the study of postmenopausal osteoporosis. Osteoporos Int 1998; 8:147-51. [PMID: 9666938 DOI: 10.1007/bf02672511] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A comparative study was performed on the sensitivity of the determination of the available biochemical markers of bone formation--total and bone alkaline phosphatase (TAP and bAP, respectively), osteocalcin (BGP), procollagen I aminoterminal propeptide (PINP) and procollagen I carboxyterminal propeptide (PICP)--in the study of postmenopausal osteoporosis. The comparison between PINP and PICP, due to the recent development of the amino-terminal assay, is of special interest. The study included 26 untreated osteoporotic postmenopausal women, age 59 +/- 6 years (range 46-69 years) and 17 healty control postmenopausal women, age 56 +/- 7 years (range 48-70 years). We found a significant increase in the levels of bAP (p = 0.0021), BGP (p = 0.041), PINP (p = 0.0001) and PCIP (p = 0.0073), but not in the levels of TAP (p = 0.3389), in osteoporotic patients with respect to the control group. Serum PINP and bAP showed the highest diagnostic accuracy among the markers of bone formation studies, as can be deduced from the receiver operating characteristics (ROC) curves. In spite of their similar origin (amino-terminal and carboxy-terminal release from a procollagen molecule), the results obtained by measuring levels of PINP are significantly better than those found with PICP.
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36
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Diaz Diego EM, Nacher M, Rapado A, Serrano S, Bosch J, Aubia J, de la Piedra C. Immunoreactive osteocalcin forms in conditioned media from human osteoblast culture and in sera from healthy adult control subjects and patients with bone pathologies. Eur J Clin Invest 1998; 28:48-58. [PMID: 9502187 DOI: 10.1046/j.1365-2362.1998.00246.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The aim of this work was to study the immunoreactive forms of bone Gla protein (BGP) present in conditioned media of human osteoblast cultures (BGP released from osteoblast) and in the sera of healthy adult control subjects and patients with bone pathologies (chronic renal failure on haemodialysis, Paget's disease of bone and post-menopausal osteoporosis). METHODS The technical procedure used was a combination of high-performance liquid chromatography (HPLC) and different BGP assays with several specificities to analyse BGP levels in the different HPLC fractions. Aliquots of conditioned media or sera were purified through a Sephadex G-50m column and by HPLC (C4 reverse-phase column) in a 25-40% acetonitrile gradient. Two-minute fractions were collected and divided into three aliquots in order to determine osteocalcin content using three different assays: (a) ELSA-OST-NAT IRMA, which only detects intact osteocalcin; (b) ELSA-OSTEO IRMA, which detects intact osteocalcin and N-terminal fragments; and (c) OSCA Test RIA, which detects intact osteocalcin, C-terminal and other fragments. RESULTS We found different immunoreactive forms of osteocalcin in the culture medium of human osteoblasts and in sera from control subjects and patients for the bone pathologies studied. We did not find great qualitative differences between the immunoreactive osteocalcin profile found in the culture medium from human osteoblasts and the sera from healthy control subjects. However, the different bone pathologies show different characteristic patterns of immunoreactive forms of osteocalcin. CONCLUSIONS An interesting finding has been the detection, both in sera and in osteoblast culture media, of several immunoreactive forms of intact osteocalcin that eluted from HPLC at different acetonitrile percentages, and therefore correspond to different molecular forms.
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Affiliation(s)
- E M Diaz Diego
- Biochemistry Laboratory, Fundación Jiménez Díaz, Madrid, Spain
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37
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Souberbielle JC, Marque D, Bonnet P, Herviaux P, Sachs C. Simple Method to Evaluate Specificity of Osteocalcin Immunoassays. Clin Chem 1997. [DOI: 10.1093/clinchem/43.9.1663] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Blumsohn A, Eastell R. The performance and utility of biochemical markers of bone turnover: do we know enough to use them in clinical practice? Ann Clin Biochem 1997; 34 ( Pt 5):449-59. [PMID: 9293302 DOI: 10.1177/000456329703400501] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- A Blumsohn
- Department of Human Metabolism and Clinical Biochemistry, University of Sheffield, UK
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39
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Bell NH. Assays for osteocalcin: all are not equal. THE JOURNAL OF LABORATORY AND CLINICAL MEDICINE 1997; 129:396-7. [PMID: 9104880 DOI: 10.1016/s0022-2143(97)90070-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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40
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Minisola S, Rosso R, Romagnoli E, D' Erasmo E, Manfredi G, Damiani C, De Antoni F, Mazzuoli G. Serum osteocalcin and bone mineral density at various skeletal sites: a study performed with three different assays. THE JOURNAL OF LABORATORY AND CLINICAL MEDICINE 1997; 129:422-9. [PMID: 9104885 DOI: 10.1016/s0022-2143(97)90075-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The purposes of this study were threefold: (1) to compare values obtained by three conventional radioimmunoassays for serum bone-gla-protein (BGP) in a population of normal women, (2) to study the relationship between serum BGP and bone mineral density (BMD) measured at four different skeletal sites (lumbar spine, proximal femur, proximal and ultradistal radius), and (3) to compare the results obtained by the three assays with conventional markers of bone turnover. Ninety-seven normal women (age range 25 to 75 years, mean +/- 1 SD = 54.3 +/- 10.9 years) were studied. Three independent assays were used to measure serum osteocalcin levels: a heterologous radioimmunoassay (RIA) (A) (Incstar Co., Stillwater, Minn.), a homologous RIA (B) (Nichols Institute, San Juan Capistrano, Calif.), and a two-site immunoradiometric assay (C) (Cis Biointernational, Gif-sur-Yvette, France). Mean +/- SD values of serum osteocalcin in the group as a whole were 4.05 +/- 1.37 microg/L by assay A, 6.03 +/- 2.90 microg/L by assay B, and 22.67 +/- 7.52 microg/L by assay C. Serum osteocalcin levels increased linearly with age; however, no correlation between serum BGP (whatever the assay used) and age was observed when only postmenopausal women were taken into account. When the effect of age was held constant by means of partial correlation analysis, only serum BGP levels measured by assays B and C were still inversely related with lumbar spine and ultradistal radius BMD; the latter assay was also weakly correlated with Ward's triangle BMD. After all the biochemical and clinical variables taken into consideration were introduced in a multiple regression equation, serum BGP still represented an important predictor of ultradistal radius and lumbar spine BMD only. Regarding relationships with other markers of bone turnover, the assay C in general showed the highest r values. In conclusion, our results indicate that commercially available BGP assays differ analytically and clinically; furthermore for the first time they show the existence of an inverse correlation between serum osteocalcin levels (which reflects bone turnover at the time of examination) and bone mass (which at a given time represents the balance of all previous metabolic events), after the influence of aging is excluded.
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Affiliation(s)
- S Minisola
- Cattedra di Medicina Interna, Istituto di II Clinica Medica, Università di Roma La Sapienza, Rome, Italy
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Takahashi M, Kushida K, Hoshino H, Ohishi T, Inoue T. Evaluation of bone turnover in postmenopause, vertebral fracture, and hip fracture using biochemical markers for bone formation and resorption. J Endocrinol Invest 1997; 20:112-7. [PMID: 9186815 DOI: 10.1007/bf03346887] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The purpose of this study is to evaluate bone turnover in postmenopausal status and established osteoporosis with vertebral fracture and hip fracture by assessing bone biochemical markers. Subjects were 50 healthy premenopausal subjects, 44 healthy postmenopausal subjects, 30 osteoporotic patients with vertebral fracture, and 31 osteoporotic patients with hip fracture. Alkaline phosphatase, osteocalcin, PICP, ICTP, NTx, free deoxypyridinoline, total pyridinoline and deoxypyridinoline were measured. In postmenopause, both Z-scores of bone formation markers and resorption markers were around 1-2. In osteoporosis, although Z-scores of bone formation markers were 0.4-2.8, resorption markers were 2.3-9.5. Moreover, Z-scores of resorption markers were higher in hip fracture than in vertebral fracture. These results indicate that bone formation and resorption increased and balanced in postmenopausal status. However, bone resorption increased more than bone formation and did not balance at all in osteoporosis. This imbalance is greater in hip fractures than in vertebral fractures.
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Affiliation(s)
- M Takahashi
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Japan
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42
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Baumgrass R, Williamson MK, Price PA. Identification of peptide fragments generated by digestion of bovine and human osteocalcin with the lysosomal proteinases cathepsin B, D, L, H, and S. J Bone Miner Res 1997; 12:447-55. [PMID: 9076588 DOI: 10.1359/jbmr.1997.12.3.447] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We have determined the primary cleavage sites in the bone Gla protein (BGP; osteocalcin) for several of the proteases that could act on the protein during bone resorption and turnover, cathepsins B, D, L, H, and S. The time course of BGP digestion by each cathepsin was first determined by sodium dodecyl sulfate polyacrylamide gel electrophoresis. We then incubated human and bovine BGP with each cathepsin for a sufficient time to reduce the level of intact protein by at least 20-fold, isolated the major cleavage peptides, and identified each by N-terminal sequence analysis and by amino acid analysis. Our results show that BGP has relatively few cathepsin-sensitive sites and that these sites are located at the N and C terminus of the 49-residue protein. Cathepsins B, L, H, and S readily cleave BGP at the G7-A8 bond; cathepsin L also cleaves at R43-R44; cathepsin B also cleaves at R44-F45; and cathepsin D cleaves only at A41-Y42. The immunoreactivity of the major peptides generated by cathepsin cleavage was evaluated using the original radioimmunoassay developed for the detection of BGP in human serum. The BGP 8-49 fragment cross-reacts identically with native BGP, while the 8-43 and the 1-44 fragments require 20- to 40-fold higher concentrations to achieve the same level of displacement as the native protein. The 1-41 and 8-41 fragments are unable to significantly displace the labeled native BGP tracer at any concentration tested. These results demonstrate the utility of peptides generated by cathepsin digestion in the mapping of the antigenic epitopes recognized by a given BGP immunoassay.
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Affiliation(s)
- R Baumgrass
- German Institute of Human Nutrition, Bergholz-Rehbruecke, Germany
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43
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Magnusson P, Degerblad M, Sääf M, Larsson L, Thorén M. Different responses of bone alkaline phosphatase isoforms during recombinant insulin-like growth factor-I (IGF-I) and during growth hormone therapy in adults with growth hormone deficiency. J Bone Miner Res 1997; 12:210-20. [PMID: 9041052 DOI: 10.1359/jbmr.1997.12.2.210] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We studied serum bone alkaline phosphatase (ALP) isoforms and other markers of bone turnover in growth hormone-deficient (GHD) adults (n = 22). The patients were followed during 1 week of insulin-like growth factor-I (IGF-I) administration, 40 micrograms/kg of body weight/day (n = 6), and during 24 months of growth hormone (GH) therapy, 0.125 IU/kg of body weight/week for the first month, and then 0.250 IU/kg of body weight/week (n = 20). Six ALP isoforms were separated and quantified by high-performance liquid chromatography: one bone/intestinal, two bone (B1, B22), and three liver ALP isoforms. At baseline, the mean levels of B1, B22, and osteocalcin were higher in GHD adults than in healthy adults. After 2 week of IGF-I administration and 1 month of GH therapy, only B1 was decreased. We suggest that the initial decrease of B1 during GH therapy could be an effect of endocrine IGF-I action mediated by GH. After 3 months of GH therapy, both B1 and B2 increased as compared with placebo. Osteocalcin, carboxy-terminal propeptide of type I procollagen (PICP), cross-linked carboxy-terminal telopeptide of type I collagen (ICTP), and urinary pyridinoline cross-links/creatinine ratio increased during GH therapy. PICP increased significantly before bone ALP and osteocalcin, indicating early stimulation of type I collagen synthesis as previously demonstrated by in vitro models. Different responses of the bone ALP isoforms during IGF-I and during GH therapy suggest different regulations in vivo.
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Affiliation(s)
- P Magnusson
- Department of Clinical Chemistry, Linköping University Hospital, Sweden
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44
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Wolthers OD, Hansen M, Juul A, Nielsen HK, Pedersen S. Knemometry, urine cortisol excretion, and measures of the insulin-like growth factor axis and collagen turnover in children treated with inhaled glucocorticosteroids. Pediatr Res 1997; 41:44-50. [PMID: 8979288 DOI: 10.1203/00006450-199701000-00007] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Correlations between knemometric (lower leg length) growth rates and urine free cortisol excretion, respectively, and serum concentrations of IGF-I, IGF binding protein-3, osteocalcin, carboxy terminal propeptide of type I collagen (PICP), carboxy terminal pryridinoline cross-linked telopeptide of type I procollagen (ICTP), and amino terminal propeptide of type III procollagen (PIIINP) were investigated in 17 asthmatic children aged 7-14 y during treatment with fluticasone propionate, 200 micrograms, and beclomethasone dipropionate, 400 and 800 micrograms/d, taken from dry powder inhalers. The study was a double blind, crossover trial with three active treatment periods and two wash-out periods. All periods were 15 d long. Overnight urine free cortisol/ creatinine x 10(6) did not correlate with knemometric growth rates or any of the serum markers. Significant correlations (Pearson's correlation coefficient, P) between knemometric growth rates and IGF-I (0.41; 0.006), IGFBP-3 (0.35; 0.02), PICP (0.44; 0.003), ICTP (0.35; 0.001), and PIIINP (0.46; 0.002) were found. Compared with fluticasone propionate, 200 micrograms, beclomethasone dipropionate, 400 and 800 micrograms, caused significant suppression of lower leg growth rate (F = 12.41; p = 0.002, and F = 23.30; p = 0.0001, respectively) and of urine free cortisol/creatinine x 10(6) (F = 10.52; p = 0.003, and F = 13.74; p = 0.001). Beclomethasone, 800 micrograms, caused suppression of PICP compared with fluticasone propionate, 200 micrograms (F = 8.31; p = 0.008), and beclomethasone, 400 micrograms (F = 7.53; p = 0.01). Both low (F = 6.82; p = 0.02) and high (F = 23.35; p = 0.0001) doses of beclomethasone were associated with reduced concentrations of ICTP, the high dose being the most suppressive (F = 4.42; p = 0.05). Beclomethasone 400 (F = 9.75; p = 0.004) and 800 micrograms (F = 23.61; p = 0.0001) resulted in reduced levels of PIIINP. Reduced short-term knemometric growth rates in children treated with inhaled glucocorticosteroids reflect suppressive effects on type I and type III collagen turnover.
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Affiliation(s)
- O D Wolthers
- Department of Paediatrics, Kolding Hospital, Denmark
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45
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Knapen MH, Eisenwiener HG, Vermeer C. Osteocalcin detection in aging serum and whole blood: stability of different osteocalcin fractions. Clin Chim Acta 1996; 256:151-64. [PMID: 9027426 DOI: 10.1016/s0009-8981(96)06418-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Human serum osteocalcin is a well known bone formation marker. On the basis of their different affinities for hydroxyapatite, the total immunoreactive osteocalcin may be separated into two fractions. Six commercial test kits for osteocalcin were compared. All kits reacted with both osteocalcin fractions but the absolute amounts found in the same serum samples differed widely. During serum storage at room temperature, there was no significant loss of osteocalcin during the first 6 h. After longer storage periods, the recorded decrease of osteocalcin depended on the system used: with two kits, over 80% of the original immunoreactive antigen was left after 9 days. It is considered that the different osteocalcin fractions may become useful as markers for different metabolic bone processes. A more precise definition of the various circulating osteocalcin fractions, and the development of separate tests for each fraction, are requirements for the optimal use of osteocalcin as a diagnostic tool for metabolic bone disorders.
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Affiliation(s)
- M H Knapen
- Cardiovascular Research Institute, University of Limburg, Maastricht, The Netherlands
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46
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Braun A, Meyer P, Cleve H, Roscher AA. Rapid and simple diagnosis of the two common alpha 1-proteinase inhibitor deficiency alleles Pi*Z and Pi*S by DNA analysis. EUROPEAN JOURNAL OF CLINICAL CHEMISTRY AND CLINICAL BIOCHEMISTRY : JOURNAL OF THE FORUM OF EUROPEAN CLINICAL CHEMISTRY SOCIETIES 1996; 34:761-4. [PMID: 8891530 DOI: 10.1515/cclm.1996.34.9.761] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We describe a simple DNA-based method to assign the two common alpha 1-proteinase inhibitor (alpha 1-antitrypsin) deficiency alleles in the Pi-system (Pi*Z and Pi*S). Two sets of mutated primers are used in the polymerase chain reaction (PCR), followed by a restriction enzyme digest of the products. The mutated forward primers create a Taq I site only if the wildtype alleles (mostly M or subtypes) are present and not in the presence of the Pi*Z or Pi*S alleles. The reverse primers are mutated for an invariant Taq I site which serves as an internal control site in order to assure the completion of the restriction enzyme digest. The digested PCR products can be clearly resolved by 2.5% MetaPhore-agarose gel electrophoresis. This simple PCR probing of the most common alpha 1-antiproteinase deficiency alleles can be routinely applied either to samples showing quantitatively decreased alpha 1-antiproteinase values in serum or to blood spots of Guthrie cards used for mass screening purposes. In addition, this method may provide the opportunity for a simple, rapid, and reliable prenatal diagnosis of alpha 1-antiproteinase deficiency in special cases.
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Affiliation(s)
- A Braun
- Dr. von Haunersches Kinderspital, Ludwig-Maximilians-Universität München, Abteilung für Klinishce Chemie und Biochemie, Germany
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47
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de la Piedra C, Rapado A, Díaz Diego EM, Díaz Martín MA, Aguirre C, López Gavilanes E, Díaz Curiel M. Variable efficacy of bone remodeling biochemical markers in the management of patients with Paget's disease of bone treated with tiludronate. Calcif Tissue Int 1996; 59:95-9. [PMID: 8687976 DOI: 10.1007/s002239900093] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The aim of this work was to evaluate the response of different biochemical bone markers to tiludronate administration in Paget's disease of bone. Ten patients (five men and five women), 56-77 years old (67 +/- 6.5), were treated for 3 months with tiludronate tablets (400 mg/day). Bone formation markers: alkaline phosphatase (AP), bone alkaline phosphatase (bAP), osteocalcin (BGP), and procollagen I carboxyterminal propeptide (PICP) in serum; and bone resorption markers: serum cross-linked carboxyterminal telopeptides of type I collagen (ICTP), urinary hydroxyproline/creatinine (Hyp/Cr), pyridinoline/Cr (Pyr/Cr), and alpha-1 collagen chain products degradation (CrossLaps) were assessed. Samples were taken before and at monthly intervals for 3 months after treatment began. The results of the present work show that serum AP and bAP are sensitive and reliable biochemical markers of bone formation in the follow-up of tiludronate in this disease. Serum PICP shows less sensitivity than serum AP, and serum BGP is not indicated as biochemical marker in these types of studies. Urinary hydroxyproline seems to be the most reliable biochemical marker of bone resorption. More studies should be performed with urinary Pyr and CrossLaps determinations. Serum ICTP is not adequate for the follow-up of tiludronate treatment in Paget's disease of bone.
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Affiliation(s)
- C de la Piedra
- Unidad Metabólica, Fundación Jiménez Díaz Avda Reyes Católicos 2, 28040 Madrid, Spain
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48
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Hellman J, Käkönen SM, Matikainen MT, Karp M, Lövgren T, Väänänen HK, Pettersson K. Epitope mapping of nine monoclonal antibodies against osteocalcin: combinations into two-site assays affect both assay specificity and sample stability. J Bone Miner Res 1996; 11:1165-75. [PMID: 8854253 DOI: 10.1002/jbmr.5650110816] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Nine monoclonal antibodies (Mabs) were raised against human recombinant osteocalcin fusion protein (rGST-hOC) or bovine osteocalcin (bOC) and selected to develop two-site immunoassays for human osteocalcin (hOC). The detection system was based on the time-resolved measurement of the fluorescence of europium chelates conjugated to the tracer Mabs. Based on the ability of the Mabs to recognize different forms of hOC (carboxypeptidase Y-digested, alkylated hOC, thermally decarboxylated hOC, recombinant forms of hOC, and tryptic peptides derived from hOC) and the information obtained from combinations of the Mabs in two-site assays, an epitope map was created. The epitope map was useful in understanding the behavior of the two-site combinations of the Mabs with serum samples. The two-site combinations could be divided into subgroups detecting either full-length hOC or full length+large NH2-terminal fragment as stimulated by the carboxypeptidase Y-digested form of hOC (it lacks four COOH-terminal residues), which with intact specific assays showed cross-reactivities ranging from 7 to 14% when compared with full-length hOC. In addition, differences were observed in the ability of the combinations to detect thermally decarboxylated hOC (lacks gamma-carboxylation at residues 17, 21, and 24) with cross-reactivities ranging from 8 to 85% when compared to gamma-carboxylated hOC. The analysis of human serum samples showed considerable differences in the concentration and stability of serum OC. This was attributed as the varying ability of the Mabs to detect different proteolytic fragments derived from hOC and/or differences in the degree of gamma-carboxylation of hOC. The in vitro generation of the large NH2-terminal fragment during incubation of the serum samples at room temperature (RT) and during prolonged storage at -20 degrees C in an undercooled state was detectable as loss of immunoreactivity (ranging from -42 +/- 17 to -50 +/- 15% in 16 h at RT, n = 3) with Mab combinations detecting only full-length hOC. Two-site combinations detecting full-length+large NH2-terminal fragment showed no loss of immunoreactivity after incubation of the serum samples at RT for 16 h. With all assays, an increase of serum OC ranging from 16 to 38% was found in postmenopausal samples (n = 24) when compared with premenopausal samples (n = 17), but the degree of statistical significance varied from not significant to p < 0.01.
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Affiliation(s)
- J Hellman
- Department of Biotechnology, University of Turku, Finland
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49
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Vinholes J, Coleman R, Eastell R. Effects of bone metastases on bone metabolism: implications for diagnosis, imaging and assessment of response to cancer treatment. Cancer Treat Rev 1996; 22:289-331. [PMID: 9025785 DOI: 10.1016/s0305-7372(96)90021-3] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- J Vinholes
- YCRC Department of Clinical Oncology, Weston Park Hospital, University of Sheffield, UK
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50
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Bowles SA, Kurdy N, Davis AM, France MW, Marsh DR. Serum osteocalcin, total and bone-specific alkaline phosphatase following isolated tibial shaft fracture. Ann Clin Biochem 1996; 33 ( Pt 3):196-200. [PMID: 8791981 DOI: 10.1177/000456329603300304] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We report the changes in osteocalcin concentrations and in total and bone specific alkaline phosphatase activity occurring in the twenty week period following tibial shaft fracture in 20 subjects. Bone formation during the healing process is reflected by progressive increases in the concentration of osteocalcin and bone specific alkaline phosphatase after week 5 and the latter correlated with the height and weight of the subject. In the early post injury period, total alkaline phosphatase activity increased whereas that of the bone isoenzyme initially fell, starting to rise again during the second week. After an immediate post injury rise, osteocalcin concentration also decreased, reaching a nadir by week 5. As only three of our subjects demonstrated delayed union, we have not been able to demonstrate that biochemical monitoring of the healing process can provide an indication of prognosis in tibial shaft fracture.
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Affiliation(s)
- S A Bowles
- Department of Clinical Biochemistry, Manchester Royal Infirmary, UK
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