Assessment of urinary bone markers for monitoring treatment of osteoporosis.

BACKGROUND: The usefulness of urinary markers of bone turnover in monitoring therapy depends on their within-person variability compared with their responses to therapy. The aim of this study was to assess the performance of two such markers on this basis. METHODS: We measured variation, during a whole year, of cross-linked N-terminal telopeptide of collagen I (NTx) and urinary deoxypyridinoline (DPD) as ratios to creatinine concentration and after log-transformation of the ratios in untreated women stratified into three bone density classes, of which the lowest was osteoporotic. We also measured changes in bone mineral density at the lumbar spine (LSBMD) and hip (FNBMD) in untreated women with normal bones and in those with moderate osteopenia and calculated the reference change value (RCV; or least significant change) at P <0.05 for all of these measures. We made the same measurements on women treated with bisphosphonates, estrogen replacement (HRT), or calcium and examined their individual responses to treatment compared with RCV. RESULTS: After 12 months on bisphosphonates, LSBMD changed more than RCV (2.55%) in 47% of women compared with 44% of those on HRT and 13% of those on calcium. Response of FNBMD was less. Log NTx (RCV= -28%) responded to bisphosphonates in 78%, regardless of BMD, but less often to HRT (67%). Log DPD (RCV= -30%) responded to bisphosphonates less frequently (31% at 12 months). CONCLUSIONS: NTx has advantages over DPD in monitoring therapy for osteoporosis when mailed urine samples are used.

Knee angles and rickets in nigerian children.

Knee angles of 2,036 normal Nigerian children up to 12 years old were measured directly or from photographs. The knees were bowed (varus) in the first 6 months. At 21 to 23 months, the distribution of angles became strongly bimodal: about half were varus and half were valgus (knock-kneed), with few in between. After this they were all valgus, with few exceptions. Hence, the change from varus to valgus in individual infants must be sudden (a few weeks), although the changeover of the whole population appears smooth and gradual. They became maximally and uniformly knock-kneed (-7.1 degrees +/- 1.4 degrees) between 3 and 3.5 years, with little change thereafter. On the other hand, 120 patients with rickets discovered during screening had large knee angles, in either sense, with a bimodal distribution and frequency maxima at +10 degrees (varus) and -12 degrees (valgus). Varus knee is uncommon after 2 years. Large knee angles between 2 and 5 years suggest rickets.