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Gajewska J, Chełchowska M, Rowicka G, Klemarczyk W, Głąb-Jabłońska E, Ambroszkiewicz J. Assessment of Biochemical Bone Turnover Markers in Polish Healthy Children and Adolescents. JOURNAL OF MOTHER AND CHILD 2024; 28:14-22. [PMID: 38639100 PMCID: PMC11027035 DOI: 10.34763/jmotherandchild.20242801.d-23-00105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 02/09/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Assessing bone turnover in paediatric populations is crucial for understanding the physiological changes occurring during skeletal development and identifying potential abnormalities. The objective of this study was to assess osteocalcin (OC), bone alkaline phosphatase (BALP), and C-terminal telopeptide of type I collagen (CTX-I) levels reflecting bone formation and resorption for age and sex in Polish healthy children and adolescents. MATERIALS AND METHODS A total of 355 healthy normal-weight children and adolescents (46.5% girls) aged 1-18 years old were recruited. Total body less head (TBLH) and spine L1-L4 were used in children to assess bone mineral density (BMD) by dual-energy X-ray absorptiometry (DXA). Bone marker concentrations were determined by immunoenzymatic methods. RESULTS Bone marker levels in girls and boys started with higher values in the first year of life and subsequently decreased until reaching a nadir during the prepubertal period. The pubertal peak values of bone markers were reached at 11-13 years old in boys and at 9-11 years old in girls. After puberty, the adolescents showed a gradual decline in bone marker concentrations to the values observed in adults. We found positive correlations between OC level and TBLH-BMD (r = 0.329, p = 0.002), TBLH-BMD Z-score (r = 0.245, p = 0.023), and L1-L4 BMD (r = 0.280, p = 0.009) in the prepubertal group. CONCLUSIONS We showed serum levels of bone turnover markers-BALP, OC, and CTX-I-in relation to age and sex in healthy Polish children and adolescents. The age intervals of these markers for girls and boys aged 1-18 years old may be clinically useful in the assessment of bone metabolism in individuals with skeletal disorders.
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Affiliation(s)
- Joanna Gajewska
- Department of Screening Tests and Metabolic Diagnostics, Institute of Mother and Child, Warsaw01-211, Kasprzaka 17a, Poland
| | - Magdalena Chełchowska
- Department of Screening Tests and Metabolic Diagnostics, Institute of Mother and Child, Warsaw01-211, Kasprzaka 17a, Poland
| | - Grażyna Rowicka
- Department of Nutrition, Institute of Mother and Child, Warsaw01-211, Kasprzaka 17aPoland
| | - Witold Klemarczyk
- Department of Nutrition, Institute of Mother and Child, Warsaw01-211, Kasprzaka 17aPoland
| | - Ewa Głąb-Jabłońska
- Department of Screening Tests and Metabolic Diagnostics, Institute of Mother and Child, Warsaw01-211, Kasprzaka 17a, Poland
| | - Jadwiga Ambroszkiewicz
- Department of Screening Tests and Metabolic Diagnostics, Institute of Mother and Child, Warsaw01-211, Kasprzaka 17a, Poland
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Ladang A, Rauch F, Delvin E, Cavalier E. Bone Turnover Markers in Children: From Laboratory Challenges to Clinical Interpretation. Calcif Tissue Int 2023; 112:218-232. [PMID: 35243530 DOI: 10.1007/s00223-022-00964-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 02/17/2022] [Indexed: 01/25/2023]
Abstract
Bone turnover markers (BTMs) have been developed many years ago to study, in combination with imaging techniques, bone remodeling in adults. In children and adolescents, bone metabolism differs from adults since it implies both growth and bone remodeling, suggesting an age- and gender-dependent BTM concentration. Therefore, specific studies have evaluated BTMs in not only physiological but also pathological conditions. However, in pediatrics, the use of BTMs in clinical practice is still limited due to these many children-related specificities. This review will discuss about physiological levels of BTMs as well as their modifications under pathological conditions in children and adolescents. A focus is also given on analytical and clinical challenges that restrain BTM usefulness in pediatrics.
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Affiliation(s)
- Aurélie Ladang
- Clinical Chemistry Department, CHU de Liège, Liège, Belgium.
| | - Frank Rauch
- Shriners Hospital for Children, McGill University, Montreal, Canada
| | - Edgard Delvin
- Centre & Department of Biochemistry, Ste-Justine University Hospital Research, Université de Montréal, Montreal, Canada
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Yildirim M, Acikgoz SB, Genc AB, Yaylaci S, Dheir H, Sipahi S. The levels of inflammatory biomarkers in hemodialysis and peritoneal dialysis patients. Rev Assoc Med Bras (1992) 2021; 67:718-723. [DOI: 10.1590/1806-9282.20210056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 03/21/2021] [Indexed: 11/22/2022] Open
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Influence of Hemodialysis Treatment on Biochemical Markers of Bone Disease. BANTAO JOURNAL 2017. [DOI: 10.1515/bj-2017-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Introduction. Bone disease is a chronic complication of chronic kidney disease and major clinical problem in hemodialysis (HD) patients. The aim of our study was to assess the influence of treatment longevity on biochemical parameters of mineral and bone metabolism in HD patients, and to identify the most important parameters. Methods. The research was observational and retrospective, involved 70 patients, mean age 58.69±12.54, divided into groups in respect to the duration of dialysis treatment (Group I-5 years, Group II-5-10 years and Group III-over 10 years). Results. Serum phosphorus was increased, but the values tend to increase along with dialysis duration - (Group I: 1.93±0.45; Group II: 1.97±0.50; Group III: 2.01±0.37; p>0,05). Calcium values were also not significantly increased based on the duration of treatment [Group I: 2.3 (2.2-2.41); Group II: 2.46 (2.15-2.6), Group III: 2.35 (2.10-2.52)]. Dialysis and PTH correlated positively in the first group of patients (Rho=0.470, p=0.013). The values of calcium and alkaline phosphatase correlated positively in all patients (Rho=0.351, p=0.003). PTH was significantly higher in the second and third compared to the first group (p=0.009 and p=0.038, respectively), and there was no significant difference between the second and the third group. Interestingly, parathyroidectomized patients had higher PTH values compared to those without parathyroidectomy (557 vs. 359 pg/ml). Conclusion. The most reliable marker for clinical monitoring of bone disease in dialysis patients is PTH. The values of calcium and phosphorus are highly variable and not reliable parameters for bone disease follow-up.
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Delanaye P, Warling X, Moonen M, Smelten N, Jouret F, Krzesinski JM, Maillard N, Pottel H, Cavalier E. Variations of parathyroid hormone and bone biomarkers are concordant only after a long term follow-up in hemodialyzed patients. Sci Rep 2017; 7:12623. [PMID: 28974744 PMCID: PMC5626722 DOI: 10.1038/s41598-017-12808-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 09/14/2017] [Indexed: 12/21/2022] Open
Abstract
End-stage renal disease is associated with mineral and bone disorders. Guidelines recommending therapies should be based on serial assessments of biomarkers, and thus on variations (Δ), rather than scattered values. We analyzed the correlations between ΔPTH and Δbone biomarkers such as bone-specific alkaline phosphatase (b-ALP), Beta-CrossLaps (CTX), osteocalcin, intact serum procollagen type-1 N-propeptide (P1NP), and tartrate-resistant acid phosphatase 5B (TRAP-5B) at different time-points. In this prospective observational analysis, variations of biomarkers were followed after 6-week (n = 129), 6-month (n = 108) and one-year (n = 93) period. Associations between variations were studied by univariate linear regression. Patients followed for one-year period were classified (increaser or decliner) according to variations reaching the critical difference. Over the 6-week period, only ΔCTX was correlated with ΔPTH (r = 0.38, p < 0.0001). Over the one-year period, correlations between ΔPTH and Δbone biomarkers became significant (r from 0.23 to 0.47, p < 0.01), except with ΔTRAP-5b. Correlations between Δbone biomarkers were all significant after one-year period (r from 0.31 to 0.68, p < 0.01), except between Δb-ALP and ΔTRAP-5b. In the head-to-head classifications (decliners/increasers), the percentage of concordant patients was significantly higher over the one-year than the 6-week period. A concordance between ΔPTH and Δbone biomarkers is observed in dialysis patients, but only after a long follow-up.
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Affiliation(s)
- Pierre Delanaye
- Division of Nephrology-Dialysis-Transplantation, University of Liège, CHU Sart Tilman (ULg CHU), Liège, Belgium.
| | - Xavier Warling
- Division of Nephrology-Dialysis, Centre Hospitalier Régionale (CHR) « La Citadelle », Liège, Belgium
| | - Martial Moonen
- Division of Nephrology-Dialysis, Centre Hospitalier Régionale (CHR) « La Citadelle », Liège, Belgium
| | - Nicole Smelten
- Division of Nephrology-Dialysis, Centre Hospitalier Bois de l'Abbaye et de Hesbaye (CHBAH), Seraing, Belgium
| | - François Jouret
- Division of Nephrology-Dialysis-Transplantation, University of Liège, CHU Sart Tilman (ULg CHU), Liège, Belgium
| | - Jean-Marie Krzesinski
- Division of Nephrology-Dialysis-Transplantation, University of Liège, CHU Sart Tilman (ULg CHU), Liège, Belgium
| | - Nicolas Maillard
- Division of Nephrology-Dialysis-Transplantation, Hôpital Nord, University Jean Monnet, Saint Etienne, France
| | - Hans Pottel
- Division of Public Health and Primary Care, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Etienne Cavalier
- Division of Clinical Chemistry, University of Liège (ULg CHU), Liège, Belgium
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Negri AL, Brandenburg VM. Calcitriol resistance in hemodialysis patients with secondary hyperparathyroidism. Int Urol Nephrol 2014; 46:1145-51. [PMID: 24384877 DOI: 10.1007/s11255-013-0637-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 12/16/2013] [Indexed: 01/06/2023]
Abstract
Nonselective vitamin D receptor activators (VDRA), such as calcitriol and alfacalcidol, have been successfully used in the treatment of secondary hyperparathyroidism (SHPT) in hemodialysis. Despite their beneficial effects on the control of serum PTH levels, their use has been limited by intolerance (development of hypercalcemia and hyperphosphatemia with consecutive cardiovascular toxicity). Apart from becoming intolerant, in 20-30 % of patients who use nonselective VDRA, serum PTH levels do not decrease appropriately despite increasing doses of these agents. These patients are considered calcitriol-resistant patients. Thus, calcitriol resistance and intolerance are two sides of the same coin: active vitamin D failure. Despite the clinical relevance of active vitamin D failure, definitions of resistance and intolerance are imprecise and have varied over time. More selective VDRA claim to produce less hypercalcemia and hyperphosphatemia and could help clinicians to overcome intolerance. Also, some studies have also shown that paricalcitol can be even useful in resistant patients. Significant limitations of iPTH as a reliable and useful clinical biomarker have been increasingly appreciated. There is evidence that intact PTH concentration must differ by 72 % between any two measurements before it can be considered a significant change. VDR polymorphisms could be involved in the development of SHPT in CKD patients. Interestingly, a higher incidence of the b allele of the VDR BsmI gene variant has been shown to be present in SHPT. The BsmI genotype can also affect the response of hemodialysis to IV calcitriol. A challenge for the future will be to establish biomarkers such as laboratory determinations or ultrasound findings that can help us to early identify those patients who will not respond appropriately to calcitriol or exhibit intolerable side effects .
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Affiliation(s)
- Armando L Negri
- Instituto de Investigaciones Metabólicas, Universidad del Salvador School of Medicine, Libertad 836 1 piso, 1012, Buenos Aires, Argentina,
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Delanaye P, Souberbielle JC, Lafage-Proust MH, Jean G, Cavalier E. Can we use circulating biomarkers to monitor bone turnover in CKD haemodialysis patients? Hypotheses and facts. Nephrol Dial Transplant 2013; 29:997-1004. [DOI: 10.1093/ndt/gft275] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
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Parathormone and bone-specific alkaline phosphatase for the follow-up of bone turnover in hemodialysis patients: Is it so simple? Clin Chim Acta 2013; 417:35-8. [DOI: 10.1016/j.cca.2012.12.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 11/08/2012] [Accepted: 12/03/2012] [Indexed: 11/20/2022]
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Kostić I, Kostić J, Mitić B, Kostić S, Đorđević V, Babović P. DISORDERS OF PHOSPHOrus-CALCium BALANCE IN PATIENTS ON CHRONIC HEMODIALYSIS - TIME-BASED DURATION RELATIONSHIP. ACTA MEDICA MEDIANAE 2011. [DOI: 10.5633/amm.2011.0106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Kostić I, Kostić J, Mitić B, Kostić S, Đorđević V, Babović P. POREMEĆAJI FOSFO-KALCEMIČNOG BILANSA KOD BOLESNIKA NA HRONIČNOJ HEMODIJALIZI – UTICAJ DUŽINE DIJALIZIRANJA. ACTA MEDICA MEDIANAE 2011. [DOI: 10.5633/amm.2011.0106s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Primary hyperparathyroidism associated with hypocalcemia in a patient presenting with kidney disease. Int Urol Nephrol 2010; 42:835-9. [DOI: 10.1007/s11255-010-9743-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2010] [Accepted: 04/13/2010] [Indexed: 10/19/2022]
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