Abstract
The utility of procollagen type 1 N-terminal propeptide (P1NP) in the management of metabolic bone diseases remains a subject of debate since the reference ranges are not rigorously established and fail to account for many of the preanalytical variables. We aimed to establish reference intervals for P1NP level in healthy and osteoporotic postmenopausal females stratified by age, body mass index and menopausal duration. We also aimed to assess the relationship between P1NP and BMD. This cross-sectional study enrolled 183 postmenopausal females who were divided in osteoporosis group (N=93) and control group (N=90) with preserved bone mass based on BMD assessed by DXA. In the osteoporosis group median P1NP was significantly higher (51.7 ng / mL; 95%CI 43.2-53.7) compared to control group (38.9 ng/mL; 95%CI 34.2-43.9)(p<0.01). After controlling for age, BMI and years since menopause, there was significant inverse association between BMD and P1NP at the femoral neck (r=-0.18), total hip (r=-0.207) and lumbar spine (r=-0.236). There was no significant difference in P1NP concentration across quartiles of age in postmenopausal females. P1NP was significantly lower in obese postmenopausal females with preserved bone mass compared to normal weight and overweight females in control and in osteoporosis group. In conclusion, we showed that P1NP is inversely associated with BMD even after controlling for age, BMI and years since menopause. Although, P1NP is significantly higher in postmenopausal females with osteoporosis compared to postmenopausal females with preserved bone mass its low specificity does not warrant its utility is diagnosing osteoporosis.
Highlights
Bone mineral density (BMD) assessed by dual-energy X-ray absorptiometry (DXA) is the most commonly used measure in the assessment of osteoporotic status, risk for fragility fracture and in the management of postmenopausal osteoporosis [ ]
We showed that procollagen type I N-terminal propeptide (P NP) is inversely associated with BMD even after controlling for age, body mass index (BMI) and years since menopause
P NP is significantly higher in postmenopausal females with osteoporosis compared to postmenopausal females with preserved bone mass its low specificity does not warrant its utility is diagnosing osteoporosis
Summary
Bone mineral density (BMD) assessed by dual-energy X-ray absorptiometry (DXA) is the most commonly used measure in the assessment of osteoporotic status, risk for fragility fracture and in the management of postmenopausal osteoporosis [ ]. BMD by DXA provides a static measure of skeletal status: a snapshot of the cumulative effects of different factors on the assessed skeletal site over the time, but does not provide a dynamic estimate of skeletal activity, which could provide insight into the changes the skeleton may undergo in the future [ ]. Bone is a dynamically and metabolically active organ that is continuously subjected to two processes: resorption and formation, collectively called bone turnover or bone remodeling. Submitted: 7 July 2013 / Accepted: 21 July 2013 ers (BMTs), released into bloodstream during remodeling process can aid in the management of postmenopausal osteoporosis as they provide dynamic information regarding skeletal status that is independent from, and often complementary to, BMD measurements [ ]. The use of reference intervals with BTMs is limited as
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