Favaretti C, Sartori L, Giannini S, Ciuffreda M, Zaninotto M, Crepaldi G; International Society of Technology Assessment in Health Care. Meeting.
Annu Meet Int Soc Technol Assess Health Care Int Soc Technol Assess Health Care Meet. 1996; 12: 8.
Centre for Technology Assessment and Quality Improvement, Veneto Region, Italy.
Osteoporosis and osteoporosis-related fractures are well recognized health and socio-economic problems. Since the incidence of the disease will increase in the near future due to the progressive aging of the population, the appropriateness of both screening and diagnostic evaluations of the osteoporotic patient is of the utmost importance. Having already demonstrated a substantial misuse in bone densitometric assessment (ISTAHC Meeting, 1995), we decided to evaluate the appropriateness of old and new biochemical markers of bone turnover (BT) in contributing to the diagnosis of the disease. Forty-nine postmenopausal healthy women, 0 to 19 years after physiological menopause, were thus selected and subsequently divided in two subgroups according to Femoral Neck bone density T-scores (FNT): Group 1 (22 patients, FNT < -1.5 SD, mean age 56.5 +/-11.2 years) and Group 2 (27 patients, FNT > -1.5 SD, mean age 55.5 +/- 11.7 years). Beside femoral, lumbar, radial, and os calcis bone density evaluations, all subjects underwent fasting blood sampling for the bone formation markers (BF) such as skeletal Alkaline Phosphatase isoenzyme (b-ALP) and Osteocalcin (BGP), as well as 24-hour and 2-hour spot urine collection for bone resorption markers (BP) such as Hydroxyproline, N-Telopeptide (NTx), Pyridinolin (Pyr) and D-Pyridinolin (D-Pyr) assays. 24 hour urine samples were further evaluated at eight-hour intervals (7 a.m. - 3 p.m., 3 p.m. - 11 p.m., 11 p.m. - 7 a.m.). Although BT markers values in our subjects were higher than those of the premenopausal reference population, no difference was found between Group 1 and 2, with the only exception of Pyr whose levels were significantly greater in osteopenic subjects (p < 0.02). BR markers were higher in the 11 p.m. - 7 a.m. and 2-hour spot collections the values being more significant for NTx (P < 0.05)> Correlations among BF and Br markers were found only 0 to 3 years after the menopause [D-Pyr vs NTx (r=0.32, P < 0.02); b-ALP vs NTx (r = 0.30, P < 0.03)]. We conclude that, in this setting, BT markers can hardly discriminate subjects with different levels of bone mass, urine collection timing greatly affect BR markers evaluations, and the usefulness of these markers is probably limited to periods of abrupt variations in bone turnover. This, together with the fact that BT markers results should be applied to a single subject and not to a group of patients, greatly affect the clinical meaning of their evaluation.
Publication Types:
Keywords:
- Alkaline Phosphatase
- Biological Markers
- Bone Density
- Bone and Bones
- Female
- Humans
- Hydroxyproline
- Menopause
- Osteocalcin
- Osteogenesis
- Osteoporosis
- metabolism
- hsrmtgs
Other ID:
UI: 102222470
From Meeting Abstracts