Estimation of bone mineral density and its correlations with homocysteine, and various other biochemical bone markers in postmenopausal women

Introduction- Omocysteine (HCY) prevents collagen cross-linking and activates osteoclast function within the bones. Bone mineral density (BMD) may be affected by Hyperhomocysteinemia via Cathepsin K. Aim- To find the correlation of BMD with biochemical bone markers. Methods- BMD was investigated by the DXA scan with the help of the Hologic QDR1000 system. As per WHO guidelines, subjects were divided into three different subsets with; normal bone mass, osteopenia, and osteoporosis. Every subject underwent routine biochemical laboratory investigations, HCY, Vitamin B12, and folic acid levels. Results-Among 355 postmenopausal women, 69% (245) had osteoporosis while 11.27% (40) had normal BMD (mean age, 53 ± 8.35 years) and 19.72% (70) had osteopenia (mean age 52.86 ± 7.93 years). The mean age in the osteoporotic group was 56.49 ± 6.65 years. The mean levels of HCY in the three groups were 15.58± 7.92 μmol/L, 16.13± 7.34μmol/L and 17.05± 5.13μmol/L, respectively. Hip BMD showed a strong inverse correlation with age (r=-0.360, p=0.002), while no significant correlations were found between weight and BMI. PTH was consistently seen to be negatively correlated with BMD at Spine (r=-0.0339, p=0.004), Forearm (r=-0.267, p=0.027), and Hip (r=-0.224, p=0.064). Conclusion- Low BMD is an important problem in postmenopausal female patients. Age and duration of menopause are independent risk predictors for the development of osteoporosis. Vitamin D levels do not predict low BMD in postmenopausal females. Weight is protective for osteoporosis especially at spine and forearm BMD. Vitamin B12 and Hcy levels did not correlate with low BMD.

Re-Classification of Carcinoma of Breast According To Molecular Classification and Its Correlation with Histologic Features

Background: Breast cancer shows marked heterogeneity which is proven by the fact that tumors with similar morphologic and immuno histo-chemical features show distinct clinical behavior and different response to therapy. This led to microarray-based global gene expression profiling (GEP) and new avenues for classifying breast cancer into molecular subtypes. Among all molecular subtypes, the worst prognosis group has been identified as triple negative phenotype (TN). Further within this group, basal like breast cancer (BLBC) was identified using a 5 marker surrogate panel including ER-PR-HER2–negative and basal markers i.e. epidermal growth factor receptor (EGFR) or Cytokeratin 5/6 (CK5/6) positive. CK 5/6 is easily available and specific IHC surrogate basal markers and can be readily included in a five marker panel in prognostication of breast cancers. BME is not limited to triple negative subtypes but is also seen in other molecular subtypes. Methods: 61 cases of invasive breast carcinoma in which detailed clinical and histological prognostic factors could be determined were classified into molecular phenotype using IHC surrogate classification. Tumors expressing basal markers CK5/6 were classified as basal marker expressing (BME) tumors and were also compared with ER, PR, Her-2/neu expressing and also triple negative tumors. These tumors were compared with various prognostic and predictive markers of invasive breast carcinoma. Results: BME was seen in 50/106 cases. Also BME showed a significant association with tumor necrosis, lymph node metastasis and high histological grade. Conclusion: BME in breast carcinomas is an independent prognostic marker and its expression is not limited to triple negative cases. An expanded surrogate panel of ER, PR, Her-2 neu, and CK 5/6 provides more prognostic value than three panel marker.