Serum bone Gla-protein as a marker of bone growth in children and adolescents: correlation with age, height, serum insulin-like growth factor I, and serum testosterone

Evaluation of growth hormone secretion and treatment

The secretion of growth hormone (GH) is regulated by a complex system that includes both neurotransmitters and feedback by hormonal and metabolic substrates. Over the last few years it has been recognized that GH release varies over a wide spectrum from deficient to excessive secretion. The diagnosis of GH deficiency is based on a combination of anthropometric and clinical signs on the one hand and an inadequate stimulated and/or spontaneous GH secretion on the other. There is no distinct boundary between deficient and sufficient GH secretion. The cut-off limit for normal GH release is accordingly relative and has increased over the past decade from 5 to 10 micrograms/l. The effect of GH therapy on growth can be evaluated only after treatment for at least 6 months. There is, therefore, an indisputable need for methods that would reflect growth response soon after the start of treatment. There are several promising biochemical candidates, e.g. the aminoterminal propeptide of type III procollagen, the carboxyterminal propeptide of procollagen I and the bone Gla-protein, which may turn out to be useful early indicators of the growth response to long-term GH therapy.

Osteoporosis as the presenting sign of leukemic relapse in an adolescent: case report and literature review

Osteoporosis in adolescence is rare and usually secondary to an underlying disease process whose diagnosis may be difficult to detect. Osteoporotic vertebral collapse is an uncommon presenting sign of acute lymphoblastic leukemia (ALL). We describe a 13-year-old boy with osteoporotic vertebral collapse secondary to relapse of ALL whose blood count and blood morphology were normal but whose 1,25 = (OH2) = vitamin D level was deficient. A combination of chemotherapy, calcitriol and calcitonin therapy was successful in reversing the process. His case is presented to describe the diagnostic and therapeutic issues involved.

Oral contraception affects osteocalcin serum profiles in young women

The serum concentrations of osteocalcin (bone Gla protein) were followed by continuous blood sampling for 24 h in 9 healthy young women before and during treatment with oestrogen/progestogen combinations for oral contraception. There were marked fluctuations during the 24 h sampling period, values ranging from 0.5 to 10.0 ng/ml. Values displayed an apparent circadian rhythm. Daytime values were on average lower than nocturnal concentrations. During treatment with oral contraceptives there was a significant decrease in osteocalcin levels but fluctuations during the 24 h sampling period were still observed. Almost all individual values obtained at 30 min intervals were lower during treatment. For the whole group the mean osteocalcin concentration decreased by 1.4 ng/ml (p less than 0.01) during treatment. In postmenopausal women high serum levels of osteocalcin are supposed to reflect increased bone turnover secondary to enhanced bone resorption. Oestrogens are known to reduce osteocalcin levels and may reduce bone resorption. In healthy young women alternative mechanisms should be considered but the reduced osteocalcin serum levels in this short-term study indicate that oral contraceptive use may influence bone metabolism.

Reduced spinal bone density in young women with amenorrhoea

To assess the influence of diminished oestrogen production on bone density, we studied 23 amenorrhoeic women and 20 controls (age range 16-29 years) divided into four groups: group 1: 6 patients with idopathic hypogonadotrophic hypogonadism with primary amenorrhoea (IHH); group 2: 5 patients with delayed puberty owing to thalassaemia major (TM); group 3: 12 patients with secondary hypothalamic amenorrhoea (HA); group 4: 20 women with normal menses (controls). Secondary sexual characteristics had developed in all except the women with TM. Groups 1 and 2 had never menstruated and group 3 had been amenorrhoeic for 6 months to 3 years. The control group was studied during the follicular phase of the cycle. None of the patients were taking oestrogens at the time of observation. Plasma concentrations were determined for 17 beta-oestradiol (E2), deidroepiandrosterone sulphate (DHEA-S), cortisol (F), prolactin (PRL), thyroid hormones (T3 and T4), and gonadotrophins (LH and FSH). Spinal bone mineral density (BMD g/cm2) was assessed by dual photon absorbiometry. BMD (mean +/- 1SD) was reduced in the patients (group 2: 0.920 +/- 0.95; group 1: 0.980 +/- 0.94; and group 3: 1.037 +/- 0.75) as compared with the controls (1.290 +/- 0.95) (P less than 0.01). In the three groups of patients, plasma E2 levels were lower than 50 pg/ml and were positively correlated with the BMD. As expected, plasma gonadotrophin levels were highly and significantly reduced (P less than 0.01) in the patients, compared with that of the controls. These results suggest that reduced spinal BMD in hypogonadic women may be related to the lack of oestrogenic influence on bone metabolism.(ABSTRACT TRUNCATED AT 250 WORDS)

Insulin-like growth factor 1 (IGF-1) in burn patients

Variations in growth factor IGF-1 levels during wound healing were assessed in 23 patients with burns of varying extent and severity. The patients were followed during the postburn period and the IGF-1 levels were regularly measured by radioimmunoassay. All patients with large burns had reduced IGF-1 levels which correlated with the surface area of burn. The most plausible reason for the suppressed IGF-1 level in these patients may be diffusion from the burned skin as we have found a strong correlation between IGF-1 and serum albumin. The reduced IGF-1 levels may contribute to impaired wound healing in these patients.

Serum osteocalcin and bone isoenzyme alkaline phosphatase in growth hormone-deficient patients: dose-response studies with biosynthetic human GH

Serum osteocalcin and bone alkaline phosphatase (BAP) were measured in samples drawn at 8 a.m. in 7 patients with GH deficiency treated with recombinant human growth hormone (rhGH) (2 IU/day subcutaneously at 8 p.m.), and 7 normal controls. Patients treated with 2 IU/day had lower BAP than controls (P less than 0.05). Further, increasing doses of rhGH were given subcutaneously to each of the 7 patients for 3 consecutive 14-day periods (2, 4, and 6 IU/day at 8 p.m.) followed by 14 days off treatment. At the end of each period, the patient was hospitalized for frequent blood sampling from 8 p.m. to 11 a.m. the following day. A dose-dependent increase in area under the curve (AUC) was seen for osteocalcin (P less than 0.05), whereas the increase in AUC for BAP just failed to reach significance (P less than 0.10). The nocturnal pattern of serum osteocalcin in patients on 4 and 6 IU/day were statistically indistinguishable from those in controls. During treatment with 2 IU/day and the off-treatment period, the pattern was significantly different from controls (P less than 0.05). In conclusion, rhGH has a dose-dependent effect on basal osteoblastic activity and the nocturnal pattern of osteocalcin. Serum osteocalcin increases within hours following rhGH administration. However, 2 IU/day is inadequate to maintain normal levels and nocturnal variation in markers of osteoblastic activity.

Osteocalcin: diagnostic methods and clinical applications

Osteocalcin is a small (Mr 5800), very interesting bone specific protein, synthesized by osteoblasts and measured in plasma as a biochemical indicator of bone formation. Many immunoassays for osteocalcin have been developed, including radio- and enzymoimmunoassays, with the use of monoclonal and polyclonal antibodies. These are used in many different clinical settings, including bone, kidney, and liver diseases. However, there is a wide range of published values for plasma osteocalcin concentrations in control and patient samples and this has hindered a more widespread adoption of osteocalcin measurement by clinicians. This review discusses how various immunoassays for osteocalcin may contribute to the wide variation of published values and suggests approaches for the development of standardized assays. For example, epitope specificity and immunoreactivity with multiple forms of osteocalcin and osteocalcin peptides in plasma are discussed. It also includes a recent update on interesting clinical applications of osteocalcin.

Serum osteocalcin (bone Gla-protein), an index of bone growth in lambs. Comparison with age-related histomorphometric changes

In 96 normal male sheep, we studied the variations with age of serum osteocalcin (bone Gla-protein), measured with an assay specific for ovine osteocalcin. We compared serum osteocalcin with the main histomorphometric parameters of bone growth measured on the metacarpus of 20 normal lambs from birth to 90 days of age. Serum osteocalcin significantly decreased with age (r = -0.70, p less than 0.001), particularly during the first 90 days of life (r = -0.85, p less than 0.001). During this growth period, serum osteocalcin was significantly correlated with the appositional rate (r = +0.73, p less than 0.001), the rate of longitudinal bone growth (r = +0.68, p less than 0.002), the rate of production of chondrocytes in the growth plate (r = +0.60, p less than 0.007), and the thickness of the growth plate (r = +0.79, p less than 0.001). In low birth weight male lambs (growth-retarded animals), serum osteocalcin was significantly lower at birth when compared to normal lambs (271 +/- 156 vs. 535 +/- 169 micrograms/l, p less than 0.001), and was also significantly correlated with histomorphometric parameters. We conclude that serum osteocalcin, which is already known as a sensitive and specific marker of bone formation, is also a sensitive biochemical marker of skeletal growth in normal and growth-retarded lambs. In addition, sheep appears as a valid animal for experimental studies on bone growth.

Reversible somatotropin deficiency (psychosocial dwarfism) presenting as conduct disorder and growth hormone deficiency

The syndrome of reversible somatotropin deficiency (psychosocial dwarfism) is characterized by environment-related impairment of stature and mental growth and growth-hormone secretion. The syndrome is well illustrated by this case report of an eight-year-old boy with psychosocial dwarfism since the third year of life. It was undetected for four years, despite his having been in regular contact with a number of health workers. After he was removed from the deleterious environment, both his growth and behaviour improved markedly, and at follow-up he had maintained this progress.

Plasma osteocalcin: biological variations and reference limits

Osteocalcin, the most abundant non-collagenous protein in the bone matrix, is partly released in blood. We have measured its concentration by a radio-immunoassay procedure in 1096 apparently healthy subjects from both sexes who came for a health screening examination. Their ages varied from 4 years to over 65 years. Venous blood was drawn in the morning from fasting subjects. Plasma osteocalcin was higher in men than in women. Its level increased significantly with age, body weight, height and bone age until age 12-13 years in girls and 14-15 years in boys. In women, osteocalcin level increased after the age of 50 years and was higher than in men. It remained constant over age 60 years in both sexes, but was higher in women. There was no effect of menstrual cycle in girls at puberty. Plasma osteocalcin did not vary with follicular and luteal phases or with the use of oral contraceptive drugs in women. The usual nonsteroid anti-inflammatory drugs had no effect on blood osteocalcin level. Reference limits according to age and sex are provided.

Abnormalities in serum osteocalcin values in children with chronic rheumatic diseases

We studied bone mineral metabolism prospectively in 113 children with chronic rheumatic diseases (juvenile arthritis, systemic lupus erythematosus, and juvenile dermatomyositis) to determine the relationship of serum levels of osteocalcin to rheumatic disease activity and corticosteroid usage, and to determine, in part, the cause of osteopenia in this population. Disease activity was quantitated by historical, clinical, and serologic means and an activity score derived. The 113 children were divided according to the expression of their disease, which was active (group 1: mean score 3.42, mean erythrocyte sedimentation rate 28 mm/hr) or inactive (group 2: score 1.7, erythrocyte sedimentation rate 15 mm/hr) (p less than 0.02 group 1 vs group 2 for each value), or which remitted during the study (group 3). We found that serum levels of osteocalcin, but not those of ionized calcium, 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D, and parathyroid hormone, were reduced in group 1 children even before corticosteroid therapy was employed. Children in both group 2 and group 3 had normal osteocalcin levels despite the use of corticosteroids. The reduced levels of osteocalcin were predictive of a reduction in bone mass measured by photon absorptiometry in 16 of 19 children so studied. We conclude that skeletal abnormalities that result in a reduced bone mass occur in the clinical course of the majority of children with active chronic rheumatic diseases, are associated with reduced osteocalcin levels, and are not related to the use of corticosteroids. Serum osteocalcin levels may be a sensitive marker for reduced osteoblast activity and bone formation in children with chronic rheumatic diseases.

Bone Gla protein (osteocalcin) assay standardization report

The major conclusion of this study is that the different laboratory assays for serum BGP give a reasonably consistent picture of bone metabolism in the metabolic bone diseases examined only if the results are expressed as a percentage of serum BGP levels in normal individuals. This requires that all laboratories establish a mean control serum BGP value in an appropriate population of normal individuals. Since BGP levels determined by different laboratories on the same serum sample can vary by more than fourfold, the absolute serum BGP levels determined in one laboratory cannot be compared directly with the serum BGP levels determined in another. Although we cannot comment on the efficacy of different laboratory assays for serum BGP as measures of bone metabolism in disease states that were not examined, such as osteoporosis, it is clear that the large differences between laboratory assays make it imperative that all interlaboratory comparisons be based on values expressed as a percentage of serum BGP in an appropriate population of normal individuals.

Insulin-like growth factor I (somatomedin C) in goats during normal lactation and in response to somatotropin treatment

1. Two experiments were performed. In Experiment 1, IGF-I concentrations in serum were followed in four lactating dairy goats during normal lactation and before, during and after 14 days of daily administration of 10 IU recombinant bovine somatotropin, starting 10 weeks post-partum. In Experiment 2, IGF-I was measured in single blood samples obtained from 40 dairy goats in the first part of lactation. 2. Measured IGF-I concentrations ranged from 4.4-9.0 nM. Concentrations varied during the day with coefficients of variation from 8.9 to 18.4% in the four goats in Experiment 1. There were no systematic trends in the diurnal variations (P greater than 0.75). 3. Concentrations of IGF-I remained fairly constant in all goats in Experiment 1 during the lactational period, and were not related to the changes in milk yield (P greater than 0.65). Similarly, no relationship was found in Experiment 2 between level of milk production and IGF-I concentration in serum. 4. Somatotropin treatment stimulated milk yields by 14 +/- 2.9% (P less than 0.05) and IGF-I concentration by 27.9 +/- 6.7% (P less than 0.05). 5. IGF-I is the most likely factor which increases mammary gland synthetic capacity in response to somatotropin treatment, and thus is responsible for the galactopoietic effect of this hormone being exerted. 6. However, serum IGF-I may primarily be involved in regulation of nutrient partitioning during normal lactation, but a paracrine synthesis with local effect on the mammary gland cannot be ruled out.

Central osteosclerosis with ectodermal dysplasia: clinical, laboratory, radiologic, and histopathologic characterization with review of the literature

IBIDS is a syndrome characterized by ichthyosis, brittle hair, impaired intelligence, decreased fertility, and short stature, but unassociated with skeletal lesions. This condition is considered a form of trichothiodystrophy because hair from several cases has been found to have a low sulfur content. We describe a 9-year and 10-month-old white boy whose clinical features resemble the IBIDS syndrome (ichthyosis, brittle hair, cataracts, and short stature), but who also has marked axial osteosclerosis and peripheral osteopenia. No abnormalities of mineral homeostasis were noted. Histopathologic assessment of nondecalcified bone specimens excluded osteopetrosis, but suggested slow skeletal remodeling. When subjected to polarized light microscopy, his hair exhibited the band-like pattern of birefringence described in trichothiodystrophy. Literature review disclosed 8 patients, 2 of whom had been diagnosed as trichothiodystrophy, with like clinical features including osteosclerosis. These skeletal abnormalities together with clinical features of the IBIDS/trichiodystrophy syndrome, we believe, reflect the prototype of a disorder that seems best described as central osteosclerosis with ectodermal dysplasia.