Age-related trends and reference intervals of cross-linked C-telopeptide of type I collagen and procollagen type I N-propeptide from a reference population of Sri Lankan adult women.

Refer ence values of bone turnover markers (BTMs) are determined by factors that are country-specific. In Sri Lanka, unavailability of BTM reference data has led to their non-use in management of osteoporosis. The results of this study can be used as reference data for women in Sri Lanka. INTRODUCTION: This study was performed to establish age-related reference intervals for bone resorption marker; cross-linked C-telopeptide of type I collagen (CTX) and bone formation marker; procollagen type I N-propeptide (PINP) in a group of Sri Lankan adult women. METHODS: Adult women (n = 347) aged 20-70 years were recruited using age-stratified random sampling technique and categorized into age groups by decades. Serum CTX and PINP concentration were measured using enzyme-linked immunosorbent assay (ELISA). The geometric mean (95% confidence interval) and 2.5th and 97.5th percentiles were calculated. ANOVA was used to compare the means between groups. RESULTS: Mean CTX levels were relatively low and remained unchanged between 20 and 49 years. After the age of 49 years, mean CTXconcentration elevated significantly until the age of 70 years (43%, p < 0.001). Mean PINP concentrations were not significantly different between age categories (p > 0.05). Reference intervals of CTX and PINP were based on 2.5th and 97.5th percentile values. Reference intervals of CTX for the age groups of 20-29, 30-39, 40-49, 50-59, and 60-70 years were 0.19-0.97 ng/mL, 0.18-0.95 ng/mL, 0.20-1.29 ng/mL, 0.17-2.20 ng/mL, and 0.17-2.85 ng/mL respectively. Reference intervals of PINP for the same age groups were 118-810 pg/mL, 119-772 pg/mL, 116-645 pg/mL, 108-684 pg/mL, and 108-715 pg/mL respectively. CONCLUSION: In Sri Lanka, bone turnover markers are not used in evaluating patients mainly due to lack of normative data. These values can be used as reference data for women in this age group.

Bone Mineral Density and Content Among Patients With Coronary Artery Disease: A Comparative Study.

INTRODUCTION: Some studies indicate an association between coronary artery disease (CAD) and osteoporosis. This case-control study examined the association between body composition and bone mineral content (BMC) and density (BMD) among patients with CAD. MATERIALS AND METHODS: A group of men (n = 73) with established CAD and age and sex matched controls (n=65) were included in the study. Data collected included socio-demographic information, disease related data (from cases), anthropometric measurements, serum vitamin D, calcium and phosphorous and body composition analysis using DEXA. Two groups were compared using independent sample t-test, Mann Whitney U-test or Chi square test. Pearson correlation and regression models were used to test the associations between body compartments. RESULTS: Among cases, the mean disease duration was 29 (range 5-192) months and 15% had triple vessel disease. Patients had higher mean total body fat mass (TBFM) (18869.7 vs 16733.0) g, p = 0.018), truncal fat mass (TRFM) (9259.1 vs 7992.5 g, p = 0.009) and fat percentage (28.6 vs 25.9%, p = 0.001) compared to controls. Median serum vitamin D level was significantly lower among patients (20.0 ng/mL) compared to controls (27.1 ng/mL) (p = 0.003). In both groups, TBFM and total body lean mass (TBLM) both showed significant positive correlations with total body BMD/BMC and regional BMDs. Of the two, TBLM emerged the best predictor of TBBMC/TBBMD. These associations were greater among patients than controls. CONCLUSIONS: TBLM appears to be the strongest predictor of TBBMD and TBBMC in patients and controls. The strength of associations was greater among patients compared to controls even after adjusting for possible confounders .

Variation of urinary and serum bone turnover marker reference values among pre and postmenopausal women in Asia: a systematic review.

PURPOSE: Bone turnover markers (BTMs) are not widely used in clinical decision-making partly due to the wide variation of the reference values. This paper describes the geographical variation in BTMs reported from Asian countries. METHOD: A systematic search was conducted using the PubMed, EMBASE, and Ovid. We searched for BTMs or individual BTMs in Asia or different countries in the Asian region. Original research which published BTM values were included while reviews, comments, and meta-analyses were excluded. RESULTS: Of 650 articles, 23 fulfilled the selection criteria and were considered for this study. Among premenopausal women, mean intact OC ranged from 3.35 in Japan to 7.38 ng/mL (55%) in Thailand while it ranged between 3.35 and 5.8 ng/mL (42%) within Japan. Mean BALP varied from 15.9 in India to 41.2 U/L (61%) in Japan whereas in India, it ranged between 15.9 and 53.7 U/L (70%). Mean sP1NP ranged from 29.5 in Japan to 38.02 ng/mL in China (22%) whereas sCTX varied from 0.26 in Thailand to 0.099 ng/mL (62%) in Japan. Among postmenopausal women, mean total OC ranged from 10.02 in India to 29.8 ng/mL (66%) in Japan and intact OC ranged between 2.69 and 9.49 ng/mL (72%) within China. Mean BALP ranged from 20.9 in Japan to 60.28 U/L (65%) in China, and within China, it ranged from 28.2 to 60.28 U/L (53%). Mean sP1NP ranged from 40.11 in China to 56.4 ng/mL (29%) in Japan whereas it ranged within China from 40.11 to 53.76 ng/mL (25%). Mean sCTX varied from 0.25 to 0.433 ng/mL (42%) between the same countries respectively while within China, it varied from 0.25 to 0.395 ng/mL (37%). Urinary BTMs showed a lesser variation. CONCLUSION: A wide inter-country and intra-country variation of serum BTMs was observed among pre and postmenopausal women in Asia. Differences in selection criteria of subjects and those inherited to analytical methods may have contributed to these differences.

Trabecular bone score and bone mineral density reference data for women aged 20-70 years and the effect of local reference data on the prevalence of postmenopausal osteoporosis: a cross-sectional study from Sri Lanka.

This paper describes age-specific BMD and TBS data of Sri Lankan women aged 20-70 years. No significant change of TBS and BMDs were seen between 20 and 50 years but a rapid decline was seen between 50 and 70 years. Prevalence of osteoporosis showed a marked difference when local reference data were used instead of manufacture provided data. INTRODUCTION: It is recommended that country-specific reference data are used when estimating diagnostic and therapeutic thresholds in osteoporosis. This study estimated normative BMD and TBS reference data for women aged 20-70 in Sri Lanka and the effect of local reference data on the diagnosis of osteoporosis among postmenopausal women. METHODOLOGY: A group of healthy community-dwelling women (n = 355) aged 20-70 was recruited from Galle district in the Southern province in Sri Lanka using stratified random sampling method. They underwent DXA adhering to the manufacturer's protocol and regional BMDs and TBS of the lumbar spine were measured. RESULTS: The highest mean BMD in the spine (0.928 g/cm2) was seen in 20-29 age group while there was a delay in achieving the peak BMD in the femoral neck (0.818 g/cm2) and total hip (0.962 g/cm2) regions(40-49 years). BMDs showed only a mild change between 20 and 49 years but a rapid decline was seen after 50 years (spine 0.013, femoral neck 0.012, and total hip 0.011 g/cm2 per year). The highest TBS was seen in 20-29 age group (1.371) and TBS trend with age was parallel to spine BMD. When the reference data provided by the manufacturer was used, 37% of postmenopausal women were found to have osteoporosis but this value changed to 17.6% when the local reference data were used. CONCLUSION: We found a significant difference in the prevalence of osteoporosis when the local reference values were used instead of data provided by the manufacturer. However, representative data from more centers and fracture data are required before a recommendation to use local instead of international reference data can be stated.

Association of metabolic syndrome with testosterone and inflammation in men.

OBJECTIVE: There is limited data on the assessment of relationship between sex hormones, metabolic syndrome (MS) and inflammation. Therefore, our objective was to examine the relationship between metabolic syndrome, testosterone and inflammation. PATIENTS AND METHODS: It was a cross-sectional study which included 309 subjects in the age range of 30-70years. Blood was analyzed for plasma glucose, serum lipids, total testosterone (TT) and high-sensitivity C-reactive protein (hs-CRP). RESULTS: There were 153 patients with metabolic syndrome and 156 without MS according to modified NCEP guidelines. Age, BMI, obesity, dyslipidaemia, smoking (OR=2.35, CI=1.35-4.09), LDL-Ch, low TT (OR=0.76, CI=0.38-1.52) and elevated hs-CRP (OR=1.56, CI=0.87-2.80) were significant independent predictors of MS (all P<0.05). CONCLUSIONS: The low testosterone and high hs-CRP levels are independent predictors of metabolic syndrome.

Association of serum testosterone with lipid abnormalities in patients with angiographically proven coronary artery disease.

CONTEXT: Low testosterone levels are associated with an atherogenic lipid profile and may contribute to the pathogenesis of atherosclerosis. AIMS: Our study aimed to investigate the relationship between serum total testosterone (TT) levels and lipid profile in angiographically confirmed coronary artery disease (CAD) in men. SETTINGS AND DESIGN: This is a case-control hospital-based study at Teaching Hospital, Karapitiya, Galle, Sri Lanka. MATERIALS AND METHODS: Two hundred and six men, 103 with angiographically proven CAD and 103 healthy men as a control group were studied. The serum levels of TT and lipids were assessed. STATISTICAL ANALYSIS: Data were analyzed using Minitab software (version 15 for Windows). RESULTS: THE MEAN CONCENTRATIONS OF LIPID PARAMETERS OF PATIENTS AND CONTROLS WERE AS FOLLOWS: Serum total cholesterol (TCh), 5.9 ± 2.8 vs. 5.2 ± 1.6 mmol/l (P = 0.022), low-density lipoprotein cholesterol (LDL-Ch), 3.9 ± 1.2 vs. 3.1 ± 0.5 mmol/l (P = 0.001), high-density lipoprotein cholesterol (HDL-Ch), 1.1 ± 0.5 vs. 1.4 ± 0.6 mmol/l (P = 0.001), and TGs, 2.0 ± 1.0 vs. 1.5 ± 0.8 mmol/l (P = 0.001); lipid levels were significantly different between the two groups. The mean levels of TT in the patients and controls were 11.4 ± 2.7 vs. 18.1 ± 7.2 nmol/l (P = 0.001), significantly different. Among CAD patients, a significant positive association was found between testosterone and HDL-Ch (r = 0.623, P = 0.001), whereas a negative association was found with LDL-Ch (r = -0.579, P = 0.001). CONCLUSIONS: Low levels of TT in men with CAD that appear together with an atherogenic lipid milieu may be involved in the pathogenesis of CAD. The observed association between testosterone and HDL-Ch suggests a protective effect of the hormone.