Age and Sex Specific Reference Ranges of Serum Type I Collagen C-telopeptide and Osteocalcin Based on Menstrual Stage / 임상검사와정도관리

BACKGROUND: Bone turnover markers (BTMs) are widely used tool for monitoring the response to osteoporosis therapy, and the normal adult reference range is the baseline value for the treatment of osteoporosis with anti-resorptive agents. This study was aimed to establish age- and sex-specific reference ranges of serum osteocalcin and serum type I collagen C-telopeptide (S-CTX) in adults based on menstrual stage. METHODS: Serum osteocalcin, S-CTX and bone mineral density (BMD) were measured in 291 adults (men: 162, women: 129), and follicle stimulating hormone (FSH) in women. Seven women whose serum FSH levels were >30 IU/mL were categorized as perimenopausal despite their regular menses. RESULTS: Among females with normal BMD, there were no difference in serum osteocalcin and S-CTX levels between premenopausal and postmenopausal women. Females with osteopenia in pre- and postmenopausal stage showed higher serum osteocalcin and S-CTX levels than females with normal BMD. For subjects with normal BMD, reference ranges of serum osteocalcin and S-CTX were 6.4~21.6 ng/mL and 0.08~0.85 ng/mL for 30~59-year-old females. For males with normal BMD, reference ranges of serum osteocalcin were 10.1~24.3 ng/mL for 30~39 years old and 7.7~22.4 ng/mL for 40~59 years old, and reference range of CTX was 0.13~1.27 ng/mL for 30~59 years old. CONCLUSIONS: This study will provide a redefinition of the criteria required in order to establish the normal reference ranges for BTMs. Moreover, we believe that our data will come in handy when used as normal reference ranges of BTMs in premenopausal women.

Effect of Soy Isoflavone Supplementation on Bone Metabolism Marker and Urinary Mineral Excretion in Postmenopausal Women

We studied the effects of soy isoflavone supplements on bone metabolism marker (serum osteocalcin, urinary deoxypyridinoline) and urinary mineral excretion (urinary Ca, Mg, Zn) in 47 postmenopausal women. There were 24 participants in the treatment group and 23 in the control group. The treatment group consumed isoflavone extract capsules daily (which contained 90 mg of soy isoflavones) for 12 weeks. The study compared before and after isoflavone intake in the following areas: Physical examination, diet survey, bone metabolism marker and urinary mineral excretion. The average age of the treatment group was 64.6 years and that of the control group was 66.5 years. There were no significant differences between the two groups in terms of height, weight and body mass index. Both groups maintained a regular diet pattern in terms of their average daily nutrient intake. There were no significant differences between the treatment group (23.9 mg) and the control group (25.4 mg) in terms of daily isoflavone intake based on diet. The analysis of bone metabolism marker changes in the treatment group after 12 weeks of taking the isoflavone supplements demonstrated significant differences in the following: Serum osteocalcin (13.7 ng/mL in befor versus 6.8 ng/mL in after) and urinary deoxypyridinoline (5.9 nmol/mmol Cr in befor versus 4.5 nmol/mmol Cr in after). The subjects in the treatment group showed no significant difference in urinary Ca excretion. But the subjects showed a significant difference in urinary Mg (131.9 mg/day in befor versus 115.6 mg/day in after) and Zn (400.5 microgram/day in befor versus 310.2 microgram/day in after) excretion in the isoflavone treatment group at the levels of p<0.001, p<0.01, respectively. No changes were made in the intake of minerals. The composition of serum osteocalcin and urinary deoxypyridinoline, and indicators of bone metabolism, including the excretion Mg and Zn, significantly decreased. As a result, bone mineral loss was lessened.

The Effect of an Epidural Corticosteroid Injection on the Early Stage of Bone Metabolism

OBJECTIVE: The purpose of this study is to find out what is the effect of epidural corticosteroid injection on bone metabolism. METHOD: We have assessed the systemic effects of a single epidural triamcinolone acetonide injection on biochemical indices of bone formation and resorption in patients with lumbosacral radiculopathy. Twenty patients who had lumbosacral radiculopathy and free from exposure to corticosteroid for at least 6 weeks were selected for this study. Patients were classifed as two groups; 1) epidural block with 2% lidocaine 3 ml and 0.9% normal saline 15 ml (4 men, 5 women; mean age 47.2+/-7.6 years) and 2) combination of triamcinolone acetonide 40 mg (5 men, 6 women; mean age 49.6+/-8.2 years). Fasting serum and the second voided urine were collected at 0, 1, 3, 7 and 14 days after the single epidural injection for bone-related biochemicalmarkers measurements. RESULTS: 1) Level of serum osteocalcin showed a significant time trend in the epidural corticosteroid injection group. Osteocalcin decreased dramatically from 11.2+/-3.4 ng/ml on day 0 to 5.9+/-2.8 ng/ml on day 1, 6.1+/-1.5 ng/ml on day 3 (p<0.05). After the initial drop, the level recovered to 9.8+/-3.7 ng/ml by day 7, and returned to preinjection level on day 14, at 10.9+/-4.1. 2) Urinary deoxypyridinoline levels did not show any significant changes. CONCLUSION: According to the above results, the epidural injection of corticosteroid may be a better therapeutic mode, with less potential for harmful effects to bone metabolism, in providing effective relief of symptoms to patients with lumbosacral radiculopaties.

Evaluation of Serum CTX and Osteocalcin Using Elecsys 2010 / 대한임상병리학회지

BACKGROUND: In contrast with bone formation markers, most of available indices of bone resorption are urine markers and show relatively high degree of variability. The serum resorption assay has therefore been developed. We evaluated serum bone-derived degradation products of type I collagen C-telopeptide (s-CTX) and serum osteocalcin by Elecsys 2010 (Hitachi Boehringer Mannheim, Tokyo, Japan). METHODS: For 18 healthy controls, 15 osteopenic and 7 osteoporotic patients samples, serum CTX and serum osteocalcin were measured by Elecsys 2010 using -CrossLaps/serum (Roche Diagnostic Corp., Indianapolis, USA) kit and N-MID Osteocalcin (Roche Diagnostic Corp. kit, respectively. DPD by Immulite (Diagnostic Products Corp., LA, USA) using Pyrilinks-D(TM) (Diagnostic Products Corp.) kit and serum osteocalcin for correlation by Gamma counter (Hewlett Packard, Meriden, USA) using ELSA-OSTEO (CIS, Cedex, France) kit were measured. RESULTS: The within-run and between-run coefficient of variation (CV) values of s-CTX were 6.41% and 6% in low concentrations and 3.84% and 7% in high concentrations, respectively. The within-run and between-run CV values of serum osteocalcin were 2.21% and 6% in low concentrations and 1.25% and 3% in high concentrations, respectively. The dilution recovery of s-CTX and serum osteocalcin was 100-169% (mean, 134%) and 80-138% (mean, 104%), respectively. S-CTX and DPD (R=0.369, P=0.019), and serum osteocalcin by Elecsys 2010 and RIA (R=0.889, P<0.001) showed positive correlations, respectively. CONCLUSTIONS: S-CTX and serum osteocalcin by Elecsys 2010 exhibits good analytical performance and correlate with DPD and serum osteocalcin by RIA, respectively. Therefore, these may replace DPD and serum osteocalcin by RIA and can be used for bone resorption and formation markers, respectively.