Diagnostic and screening utility of biochemical markers for osteoporosis and osteopenia in Saudi women

Postmenopausal osteoporosis is a major health problem worldwide and in Saudi Arabia as it leads to bone fragility and increased liability for fragile fractures, particularly in neck of femur and vertebrae. The present study was designed to determine the value of different screening tests to find out the most sensitive serum and urinary markers of osteoporosis among Saudi women and to clarify the relationship between E[2] deficiency and these markers in peri-menopause, early or postmenopausal women without hormonal replacement therapy. This study included 37 Saudi women aged 40 to 60 years. They were categorized into 3 groups according to their bone mineral density [BMD]: Group I: 15 Normal control [T-score up to -1.5], Group II: 12 Osteopenic women [T-score between -1.5 to 2.5]and Group III:10 Osteoporotic women [T-score below 2.5]. For all subjects, dual energy X-ray absorptiometry [DEXA] was performed. Osteocalcin [OC], alkaline phosphatase [ALP], free galactosyl hydroxylysine [Gal-Hyl], calcium [Ca], inorganic phosphorus [P] and estradiol [E[2]] were measured in serum, whereas, deoxypyridinoline [Dpd] and creatinine levels were measured in urine. Simultaneously both osteopenic and osteoporotic groups showed significant decreases in BMD when compared to the controls. Osteocalcin, ALP and Gal-Hyl showed significant increase [p<0.0001] among the osteopenic and osteoporotic groups versus the control group. Significant decrease in E[2] levels were obvious among the osteopenic [p<0.0001] and osteoporotic [p<0.0001] women when judged against the controls. Urinary Dpd was significantly increased in the osteopenic and osteoporotic groups [p<0.001]. In osteoporotic group, significant negative correlations were observed between OC and BMD. Positive correlations were detected among the osteoporotic group between OC and ALP and between OC and Gal-Hyl. High significant negative correlations were confirmed between E[2] and OC among both the osteopenic and the osteoporotic groups. Also, a significant negative correlation was established between E[2] and Dpd in the osteoporotic group. In comparing between osteopenic and osteoporotic groups, significant decrease was recognized in BMD and significant increase was predicted regarding ALP, [p<0.05], Gal-Hyl [p<0.0001] and Dpd [p< 0.001]. Urinary Dpd may be a simple indicator for osteoporosis in postmenopausal women; however, screening should include the measurement of serum estradiol, galactosyl hydroxylysine, alkaline phosphatase and Osteocalcin to increase the sensitivity and specificity of primary screening to identify the groups at higher risk of osteoporosis which is the keystone in prevention of disabling fragility fractures

Macrophage migration inhibitory factor in systemic lupus erythematosus and its expression in lupus nephritis

The aim of this study was to access the potential involvement of MIF in SLE, its relationship with corticosteroid dose, also, to measure serum and urinary MIF levels in SLE as well as detecting renal MIF expression in SLE GN. Serum and urine MIF concentrations were measured by enzyme-linked immunosorbent assay in 20 SLE female patients with lupus nephritis, World Health Organization class II, III, IV, with mean age of 35.15 +/- 10.42 years and in 10 normal healthy, age matched, female volunteers. All patients were subjected to detailed clinical assessment and laboratory investigations. Serum and urinary MIF concentrations were measured by ELISA technique. Renal MIF expression was assessed by immunostaining of biopsy tissue. Univariate and multivariate regression analysis were used to examine the associations between serum and urine MIF concentrations, renal MIF expression, disease-related indices of SLE and corticosteroid use. A statistically significant 2.98-fold-increase was detected in mean urinary MIF [U MIF] levels in SLE patients compared to controls. While, mean Serum MIF [S MIF] showed no significant difference between cases and control. Both S and U MIF concentrations were positively correlated with SLICC/ACR DI but not with SLEIDAI. Corticosteroid doses showed a highly positive correlation with S MIF, serum creatinine and SLICC/ACR DI. Also a positive correlation was found between the different histopathologic grades of renal affection and the U MIF. Immunohistochemistry staining of all normal kidney specimens showed that MIF is constitutively weakly expressed by some glomerular and parietal epithelial cells and by most tubular epithelial cells. In contrast, there was a significant increase in glomerular and tubular MIF protein staining in SLE nephropathy. This increased MIF expression correlated positively with both S MIF and U MIF, SLICC/ACR DI and the daily steroid dose. This study shows that serum MIF is over-expressed in SLE patients and that the urine MIF concentration is significantly increased in SLE World Health Organization class IV patients and correlates with the degree of renal injury. Thus, urine MIF levels reflect MIF expression within the kidney