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01-07-2015 | Review

Bone turnover markers in Paget’s disease of the bone: A Systematic review and meta-analysis

Authors: A. A. Al Nofal, O. Altayar, K. BenKhadra, O. Q. Qasim Agha, N. Asi, M. Nabhan, L. J. Prokop, P. Tebben, M. H. Murad

Published in: Osteoporosis International | Issue 7/2015

Abstract

Summary

The aim of this systematic review and meta-analysis is to study the utility of the commonly used bone turnover markers in evaluating disease activity in patients with Paget’s disease of bone before and after treatment with bisphosphonates. We found good correlation between the bone turnover marker concentrations and disease activity assessed by bone scintigraphy.

Introduction

Paget’s disease of bone is a common skeletal disorder of the elderly. Bone turnover marker concentrations are used for diagnosis and follow-up. We aimed to compare the available bone turnover markers and determine their utility in assessing disease activity when compared to quantitative bone scintigraphy.

Methods

We conducted a systematic review and meta-analysis searching MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus. We evaluated total alkaline phosphatase (total ALP), bone-specific alkaline phosphatase (bone ALP), procollagen type 1 amino-terminal propeptide (P1NP), serum, and urine C-terminal telopeptide (uCTx and sCTx, respectively), and urine N-terminal telopeptide (uNTx). The main outcome of interest was the correlation of disease activity with concentrations of bone turnover markers in Paget’s disease patients before and after treatment with bisphosphonates. Correlation coefficients were pooled across studies using the random effects model.

Results

We included 17 observational studies and one trial reporting on 953 patients. Prior to treatment, all studied bone turnover markers had moderate to strong correlation with scintigraphic indices (correlation coefficients ranging from 0.58 to 0.80) with no statistically significant difference between the bone turnover markers overall (p = 0.08). P1NP, uNTx, and bone ALP tend to have higher correlation with scintigraphy. After starting treatment with bisphosphonate, there was moderate to strong correlation with disease activity with all markers except bone ALP (correlation coefficients ranging from 0.43 to 0.70).

Conclusion

The findings of this meta-analysis suggest the Paget’s disease activity is best monitored by following P1NP levels. However, total ALP, bone ALP, and uNTx are good alternatives as markers of disease activity in untreated patients. Total ALP and uNTx can be useful in following patients with Paget’s disease after treatment if P1NP is not available. Clinicians, however, should take availability, cost, and the presence of liver disease into consideration when deciding which bone turnover marker is most appropriate when evaluating patients with Paget’s disease.

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Title: Bone turnover markers in Paget’s disease of the bone: A Systematic review and meta-analysis
Authors: A. A. Al Nofal
O. Altayar
K. BenKhadra
O. Q. Qasim Agha
N. Asi
M. Nabhan
L. J. Prokop
P. Tebben
M. H. Murad
Publication date: 01-07-2015
Publisher: Springer London
Published in: Osteoporosis International / Issue 7/2015
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI: https://doi.org/10.1007/s00198-015-3095-0

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Bone turnover markers in Paget’s disease of the bone: A Systematic review and meta-analysis

Abstract

Summary

Introduction

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Summary

Introduction

Methods

Results

Conclusion

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