RESEARCH - Correlation of different bone markers with BMD in patients with rheumatic diseases on steroids

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Rheumatol Int. 2006 Feb;26(4):331-6. Epub 2005 May 11.

Correlation of different bone markers with bone density in patients with

rheumatic diseases on glucocorticoid therapy.

Loddenkemper K, Bohl N, Perka C, Burmester GR, Buttgereit F.

Department of Rheumatology and Clinical Immunology,

Charite-Universitatsmedizin Berlin Campus Charite-Mitte, Charite University

Hospital, Schumannstrasse 20/21, 10117, Berlin, Germany,

konstanze.loddenkemper@....

Osteoporosis is a common concomitant disease in patients with rheumatic

diseases on glucocorticoid (GC) therapy. Bone status is usually evaluated by

determination of bone density in combination with clinical examinations and

laboratory tests. However, the strength of individual biochemical bone

makers in GC-induced osteoporosis has yet to be fully clarified. For this

reason, different bone markers were investigated in correlation with bone

density in patients with rheumatic diseases. Approximately 238 patients (212

women, 26 men) with a rheumatic disease and under GC therapy were examined

consecutively for the first time with regard to bone density (BMD) and bone

markers {osteocalcin, bone-specific alkaline phosphatase (precipitation

method/tandem-MP ostase), crosslinks [pyridinoline (PYD), deoxypyridinoline

(DPX), N-terminal telopeptide (NTX)]}. The daily glucocorticoid dose was 10

mg prednisone equivalent (median), and the cumulative dose was 12 g

prednisone equivalent (median). None of the patients had previously taken

medication for osteoporosis. Osteoporosis was demonstrated in 35.3% of the

patients, osteopenia in 47.5%, and a normal BMD in 17.2%. The results of

tandem-MP ostase correlated with the BMD of the lumbar spine and of the

femoral neck. The values for N-terminal telopeptide and pyridinoline

correlated only with the bone density of the femoral neck. All results were

statistically significant, although the correlation coefficients were low.

After classification of the patients according to their BMD values

(osteoporosis, osteopenia and normal BMD), there were significantly more

patients with bone markers above the norm in the osteoporosis group and in

the osteopenia group than in the group with normal bone density. All bone

markers recorded behaved similarly in relation to the bone density values.

The same analysis was also undertaken for the different disease groups. In

these subgroups there was also a correlation between ostase/crosslinks with

BMD, but the correlation coefficients were low.

A general recommendation for

the routine use of a specific bone marker in patients with rheumatic

diseases on glucocorticoid therapy cannot be made from a cost-benefit point

of view mainly because of limited predictive power (low correlation

coefficients, incomplete correlation with different sites of BMD

measurement).

PMID: 15887044

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=pubmed & dopt=Abstra\

ct & list_uids=15887044 & itool=iconabstr & query_hl=11 & itool=pubmed_DocSum

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