Abstract
The serum N-terminal telopeptide of type I collagen (NTx) is significantly higher in patients with Crohn disease (CD) than in healthy individuals and patients with ulcerative colitis. This study aimed to investigate whether an elevated serum NTx level is a risk predictor of osteoporosis in patients with CD. Based on whether the femoral Z-score decreased over a 2-year period, 41 CD patients were divided into the ΔZ-score <0 group (Z-score decreased) and the ΔZ-score ≥0 group (Z-score did not decrease). The risk predictors of a femoral Z-score decrease were examined. Furthermore, we investigated the correlations between the ΔZ-score (which represents the change in the Z-score over a 2-year period) and the mean levels of biomarkers, including the Crohn Disease Activity Index (CDAI), serum albumin, C-reactive protein, and bone metabolism markers (including NTx) measured initially (i.e., in our previous study) and 2 years later (present study). The relationships between anti-tumor necrosis factor α (anti-TNF-α) therapy and serum NTx levels were also examined. Although there was no correlation between the mean CDAI and the ΔZ-score, the mean serum NTx and albumin levels were significantly correlated with the ΔZ-score (P<0.01 and P = 0.02, respectively). Furthermore, the femoral Z-score tended to be lower in the anti-TNF-α administration group than in the non-administration group. These observations indicated that an elevated serum NTx could be a useful marker for predicting a decrease in the femoral bone mineral density in CD patients. Anti-TNF-α therapy maintained an elevated serum NTx level, suggesting that treatment with anti-TNF-α may help control increased bone resorption in CD patients.
Highlights
Inflammatory bowel disease (IBD), which includes Crohn disease (CD) and ulcerative colitis (UC), is associated with a high incidence of osteoporosis [1,2,3,4,5,6]
We investigated the correlations between the ΔZ-score and the mean levels of biomarkers, including the Crohn Disease Activity Index (CDAI), serum albumin, C-reactive protein, and bone metabolism markers measured initially and 2 years later
In a previous cross-sectional study [23], we examined the association between biochemical bone metabolism markers (namely bone-specific alkaline phosphatase (BAP), NTx, undercarboxylated osteocalcin (ucOC), and 1,25-dihydroxyvitamin D [1,25(OH)2D]) and bone density in IBD patients and reported that the serum NTx level, a biochemical marker predicting an increase in bone resorption, is significantly elevated in patients with CD receiving infliximab (IFX)
Summary
Inflammatory bowel disease (IBD), which includes Crohn disease (CD) and ulcerative colitis (UC), is associated with a high incidence of osteoporosis [1,2,3,4,5,6]. Biochemical bone metabolism markers are used for evaluating the state of bone metabolism These markers are classified into bone formation markers, which include bone-specific alkaline phosphatase (BAP) and the N-terminal propeptide of type I collagen; bone resorption markers, which include the C- and N-terminal telopeptides (NTx) of type I collagen; and bone matrix-related markers, which include undercarboxylated osteocalcin (ucOC; related to vitamin K deficiency) [14,15,16,17]. The serum N-terminal telopeptide of type I collagen (NTx) is significantly higher in patients with Crohn disease (CD) than in healthy individuals and patients with ulcerative colitis.
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