[The role of biochemical markers of bone turnover in the diagnosis of osteoporosis and predicting fracture risk]. / Intérêt des marqueurs du remodelage osseux dans le diagnostic de l'ostéoporose et la prediction du risqué de fracture.

BACKGROUND: Currently, for the diagnosis of osteoporosis, we search risk factors and measure bone mineral density (BMD) by DXA method. However, bone turnover markers, unused still in practice, have shown an interest especially in the prediction of fracture risk. aim: To determine the relationship between bone markers, BMD and osteoporotic fracture. methods: Prospective study of 65 women referred for measure of BMD during the period between May and August 2010. Each patient had a dosage of serum bone formation markers: osteocalcin (OC) and N-terminal propeptide of type I collagen (P1NP) and bone resorption markers: serum and urinary C-terminal telopeptide of type I collagen (ß-CTX or CrossLaps) as well as parathyroid hormone and calcium. Risk factors of osteoporosis were identified in each case. results: Our 65 women had a mean age of 58.6 ± 12.1 years. The majority (83%) were menopausal women. Osteoporosis was found in 52%, osteopenia 26% and normal BMD 22% of cases. An increase in bone turnover markers was correlated with menopause (p = 0. 001 for the OC, p = 0.016 for urinary CTX), a low body mass index (p = 0.015 for OC, p = 0.042 for serum CTX) and osteoporosis (p <0.001 for P1NP, p <0.001 for serum and urinary CTX). Corticosteroid therapy was correlated with a decrease in bone formation markers (p = 0.002 for P1NP). The presence of fracture was only associated with increased urinary CTX (p = 0.05). CONCLUSION: Bone turnover markers increase in menopausal women and in case of low BMD. However, their contribution in the diagnosis of osteoporosis is low. They are rather an interest in the prediction of fracture risk.

[Prevalence of bone loss in adult celiac disease and associated factors: a control case study]. / Prévalence de la perte osseuse au cours de la maladie coeliaque de l'adulte et facteurs associés: Etude cas témoins.

BACKGROUND: Bone loss in celiac disease (CD) is important and is associated to increased risk of fractures. The determining factors of this Bone loss and the osteoporosis fracture during this disease remain still unknown. The bone remodeling parameters seem to play it an important role. AIM: Through a transverse study including 30 patients with adult CD and 30 witnesses, we estimated bone mineral density (BMD) profile of these patients and determined associated factors to the bone loss. METHODS: Patients and witnesses benefited from an BMD measure, serum calcium and phosphore, alkaline phosphatasis, parathormone and hydroxyvitamin D dosage, bone remodeling parameters containing the osteocalcin, Propeptide N-terminal of the type I procollagen, BTélopeptide C-terminal ( B-CTX) of the type I procollagen I (bloody and urine CrossLaps). The patients benefited from a malabsorption bilan, a radiological examination of spine and an evaluation of the adhesion to the regime without gluten with a histological control. RESULTS: Our population consists of 3 men (10 %) and 27 women (90 %) with an average age of 30.4 years (19-50 years). The average delay of the diagnosis of the MC is of 46.7 months. The alkaline phosphatases, the P1NP and the bloody crossLaps were more raised at the patient's with regard to the witnesses with respectively p=0.038, p=0.041 and p=0.021. The parathormone was also more raised at the patients but without significant difference 67.8 vs 53.8 ng / l. The DMO is low at 21 patients (70 %) versus 2 witnesses only (6.6 %), with an osteoporosis in 3 patients (10 %) and an osteopenia in 18 patients (60 %). Factors associated to the BMD decline are low body mass index, nulliparity, diagnostic delay > to 2 years, the malabsorption syndrome, exaggerated intraepithelial lymphocytosis at the time of the histological control, an increase of bone remodeling parameters notably the alkaline phosphatasis, osteocalcin and bloody CrossLaps. While the BMD is more raised at the patient's having followed gluten regimens during more than 5 years. The age, the sex, the symptomatic character or not of the disease, the parathormone, hydroyviamin D and fractures are not correlated to the BMD profile patients. CONCLUSION: The bone loss is more frequent during the adult CD than in the general population. His research has to become integrated into the coverage of this disease notably in the presence of risk factors. The absence of correlation between BMD loss and fractures underlines the importance of others factors in determining of bone fragility during this affection.