Markers Of Bone Turnover In Children Research Articles

Retraction Note: Bone turnover markers in children and adolescents with environmentally determined short stature, living in the oil and gas processing region.

Retraction Note: Bone turnover markers in children and adolescents with environmentally determined short stature, living in the oil and gas processing region.

Ambient ozone exposure and bone turnover markers in children: Results from the GINIplus and LISA birth cohorts

Ambient ozone exposure and bone turnover markers in children: Results from the GINIplus and LISA birth cohorts

Mineral and bone metabolism in children with a dystrophic form of сongenital epidermolysis bullosa: the effect of Cholecalciferol therapy

In the dystrophic form of CEB (DEB), malnutrition is more often observed with prominent deficiency of micro- and macroelements, especially calcium and vitamin D, that can lead to rickets and osteoporosis with fractures.Aim of the study. To study the features of mineral and bone metabolism in patients with DHE and evaluate the effectiveness of prescribing different doses of vitamin D.Methods and mаterials. The study group included 71 children with DEB (girls 55 %, boys 45 %), the median age was 8.5 years [3.67; 11.92] and 5.75 years [3.13; 10.46], respectively. All patients underwent a complex laboratory and instrumental examination before and after 6 months of Cholecalciferol therapy.Results. We found a high rate of vitamin D insufficiency (22.5 %) and deficiency (40 %), hypocalcemia of total calcium (40 %), a decrease in bone mineral density (BMD) down to osteopenia (33.8 %) and osteoporosis (19.7 %). Osteocalcin (OC) and C-terminal telopeptide of type I collagen (CTx-1) levels in the group of patients with hypocalcemia were significantly lower than in the subgroup with normal levels of calcium (p=0.001 for OC, p=0.015 for CTx-1). Wasting of higher degree was noted in the group with hypocalcemia (p=0.001). 53.6 % of patients took Cholecalciferol irregularly (IU 1100 IU [700; 1500]), 35.2 % of patients constantly took the medicine (IU 2000 IU [1000; 3000]) (p = 0.021). After 6 months, normal levels of 25(OH)D were noted in 62 % of children; the levels of P1NP (p<0.001), phosphorus (p=0.012) decreased, and BMD improved (p=0.024). According to the plan developed in our study, with level of 25(OH)D ≤ 30 ng/ml, children aged 1–7 years old should be given at least 1500 IU; at 7–12 years – 2500 IU; at 12–18 years – 3000 IU.Conclusion. To achieve optimal levels of vitamin D, calcium, and bone turnover markers in children with DEB, it is necessary to use a personalized approach for colecalciferol prescription.

Broad application prospects of bone turnover markers in pediatrics.

BackgroundBone turnover markers (BTMs) have been studied for application in clinical medicine. However, BTMs in children are challenging, and few studies explore these BTMs in children. The application of BTMs is complicated mainly due to pre‐analytical factors, variable reference intervals of age‐ and sex‐related BTMs for adolescents and children in different regions and laboratories. Therefore, laboratory testing of BTMs is critical for understanding pediatric bone development and metabolism, which provides additional information about bone development and diseases.MethodsLiterature search was conducted using the MeSH term “child” combined with the terms that bone turnover markers such as “osteocalcin,” “Procollagen type I N‐terminal propeptide,” “procollagen type I C‐terminal propeptide,” “osteocalcin,” “N‐terminal cross‐linked telopeptide,” and “C‐terminal cross‐linked telopeptide,” Several databases including Web of Science, Google Scholar, and PubMed were searched to obtain the relevant studies.ResultsBTMs represent the combined effects of skeletal development, growth, and remodeling in children, which can be used in clinical pediatrics to assist in the diagnosis and prognosis of bone metabolic disorders.ConclusionBTMs are clearly helpful for diagnosis and monitoring of bone growth and development as well as bone metabolic disorders.

Ambient ozone exposure and bone turnover markers in children: Results from the GINIplus and LISA birth cohorts

BackgroundMultiple environmental factors can regulate bone metabolism, and it is hypothesized that air pollution may be deleteriously involved in this regulation. However, only a few studies considered bone turnover markers (BTMs) - sensitive and specific markers of bone metabolism - as outcomes, and no study investigated the exposure to ambient ozone. Here, we intended to explore the associations between long-term exposure to ambient ozone and concentrations of two BTMs, osteocalcin and β-isomer of C-terminal telopeptide of type I collagen (CTx), amongst 10-year-old children. MethodsBased on the GINIplus and LISA birth cohorts, our cross-sectional analysis included 1848 children aged 10 years from Munich and Wesel. Serum osteocalcin and CTx concentrations were measured. We estimated ozone exposures by optimal interpolation, assessed nitrogen dioxide and particulate matter with an aerodynamic diameter <10 μm concentrations by land use regression models, and assigned the exposures to home addresses. Linear regression models were built and adjusted for covariates as well as co-pollutants. ResultsThe mean concentrations were 93.09 ng/mL and 663.66 ng/L for osteocalcin and CTx, respectively. In general, higher levels of ozone were associated with decreased concentrations of both BTMs. This held true for the two areas and different exposure metrics. The number of days per year with a maximum 8-h average concentration exceeding 120 μg/m³ showed consistent results across different models. Specifically, models adjusted for co-pollutants illustrated that the beta estimates and 95% confidence intervals on osteocalcin and CTx were −2.51 (−3.78, −1.14) and −44.53 (−57.12, −31.93), respectively, for an increase of 10 days. ConclusionsWe found that long-term exposure to ambient ozone was associated with decreased concentrations of BTMs in German children. This association might potentially affect bone metabolism. Nevertheless, unless other prospective studies confirm our results, the detrimental effects of ambient ozone on bone development in children should be interpreted cautiously.

M304 The impact of obesity on bone turnover markers in children

M304 The impact of obesity on bone turnover markers in children

Bone Density, Geometry, and Mass by Peripheral Quantitative Computed Tomography and Bone Turnover Markers in Children with Diabetes Mellitus Type 1.

Background The type 1 diabetes mellitus (T1DM) is a chronic systemic autoimmune-mediated disease characterised by the insulin deficiency and hyperglycaemia. Its deleterious effect on bones concerns not only bone mass, density, and fracture risk but also may involve the linear growth of long bones. Studies on the lower leg in children with T1DM by pQCT have generated conflicting results, and most of the studies published so far focused only on a selected features of the bone. An additional information about growth, modelling, and remodelling processes can be gathered by the bone turnover marker measurement. The objective of the study was to evaluate bone mineral density, mass, and geometry using peripheral quantitative computed tomography as well as bone turnover markers in the patients with type 1 diabetes mellitus. Material and Methods. Bone mineral density, mass, and geometry on the lower leg using peripheral quantitative computed tomography and serum osteocalcin (OC) and carboxyterminal cross-linked telopeptide of type 1 collagen (CTx) were measured in 35 adolescents with T1DM (15 girls) aged 12.3-17.9 yrs. The results were compared to age- and sex-adjusted reference values for healthy controls. Results Both sexes reveal lower than zero Z-scores for lower leg 66% total cortical bone cross-sectional area to muscle cross-sectional area ratio (−0.97 ± 1.02, p = 0.002517 and −0.98 ± 1.40, p = 0.007050, respectively) while tibia 4% trabecular bone density Z-score was lowered in boys (−0.67 ± 1.20, p = 0.02259). In boys in Tanner stage 5 bone mass and dimensions were diminished in comparison to Tanner stages 3 and 4, while in girls, such a phenomenon was not observed. Similarly, bone formation and resorption were decreased in boys but not in girls. Consistently, bone turnover markers correlated positively with bone size, dimensions, and strength in boys only. Conclusions T1DM patients revealed a decreased ratio of cortical bone area/muscle area, reflecting disturbed adaptation of the cortical shaft to the muscle force. When analyzing bone mass and dimensions, boys in Tanner stage 5 diverged from “less-mature” individuals, which may suggest that bone development in these individuals was impaired, affecting all three: mass, size, and strength. Noted in boys, suppressed bone metabolism may result in impairment of bone strength because of inadequate repair of microdamage and accumulation of microfractures.

Bone Turnover Markers in Children: From Laboratory Challenges to Clinical Interpretation.

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.

Effect of fasting hyperglycemia and insulin resistance on bone turnover markers in children aged 9-11years.

Impaired regulation of glucose metabolism in childhood adversely affects bone health. We assessed the effect of fasting hyperglycemia and insulin resistance on bone turnover markers in prepubertal children with normal glycemia (<100mg/dL) and fasting hyperglycemia (100-125mg/dL). Glucose, hemoglobin A1c, IGF-I (insulin-like growth factor I), iP1NP (N-terminal propeptide of type I procollagen), CTX-1 (C-terminal telopeptide of type I collagen) and insulin were measured. Bone turnover index (BTI) and HOMA-IR (homeostasis model assessment) were calculated. Bone resorption marker (CTX) levels were decreased by 26.5% in boys with hyperglycemia, though only 7% in girls. Hyperglycemia had no effect on the bone formation marker iP1NP. IGF-1, the best predictor of bone marker variance accounted for 25% of iP1NP and 5% of CTX variance. Girls presented significantly higher BTI indicating the predominance of bone formation over resorption. Insulin resistance significantly decreased CTX. In girls, HOMA-IR and IGF-1 predicted 15% of CTX variance. Fasting hyperglycemia and insulin resistance in children impact bone turnover suppressing bone resorption. Hyperglycemia decreased resorption, particularly in boys, while suppression of resorption by insulin resistance was more pronounced in girls. We suggest that the progression of disturbances accompanying prediabetes, may interfere with bone modelling and be deleterious to bone quality in later life.

A Three-Year Longitudinal Study Comparing Bone Mass, Density, and Geometry Measured by DXA, pQCT, and Bone Turnover Markers in Children with PKU Taking L-Amino Acid or Glycomacropeptide Protein Substitutes.

In patients with phenylketonuria (PKU), treated by diet therapy only, evidence suggests that areal bone mineral density (BMDa) is within the normal clinical reference range but is below the population norm. Aims: To study longitudinal bone density, mass, and geometry over 36 months in children with PKU taking either amino acid (L-AA) or casein glycomacropeptide substitutes (CGMP-AA) as their main protein source. Methodology: A total of 48 subjects completed the study, 19 subjects in the L-AA group (median age 11.1, range 5–16 years) and 29 subjects in the CGMP-AA group (median age 8.3, range 5–16 years). The CGMP-AA was further divided into two groups, CGMP100 (median age 9.2, range 5–16 years) (n = 13), children taking CGMP-AA only and CGMP50 (median age 7.3, range 5–15 years) (n = 16), children taking a combination of CGMP-AA and L-AA. Dual X-ray absorptiometry (DXA) was measured at enrolment and 36 months, peripheral quantitative computer tomography (pQCT) at 36 months only, and serum blood and urine bone turnover markers (BTM) and blood bone biochemistry at enrolment, 6, 12, and 36 months. Results: No statistically significant differences were found between the three groups for DXA outcome parameters, i.e., BMDa (L2–L4 BMDa g/cm2), bone mineral apparent density (L2–L4 BMAD g/cm3) and total body less head BMDa (TBLH g/cm2). All blood biochemistry markers were within the reference ranges, and BTM showed active bone turnover with a trend for BTM to decrease with increasing age. Conclusions: Bone density was clinically normal, although the median z scores were below the population mean. BTM showed active bone turnover and blood biochemistry was within the reference ranges. There appeared to be no advantage to bone density, mass, or geometry from taking a macropeptide-based protein substitute as compared with L-AAs.

Effect of Cholecalciferol Supplementation on Bone Turnover Markers in Children and Adolescents With Type 1 Diabetes Mellitus

Background: Cholecalciferol is known to play an important role in bone mineral metabolism. Its deficiency may affect growth and status of bone markers in children. Aim of the study: to evaluate the correlation between serum 25(OH)D and bone markers and impact of vitamin D supplementation on serum bone formation [procollagen type 1 amino-terminal propeptide (P1NP)] and bone resorption [β-cross laps (CTx)] markers among children and adolescents with type 1 diabetes mellitus (DM). Materials and Methods: Total 58 children and adolescents with type 1 DM, who were given 2000 UI of cholecalciferol supplementation, were included in the study. These 58 children with available anthropometry, serum biochemistry, 25-hydroxyvitamin D ([25(OH)D]), and parathormone (PTH) were evaluated for bone formation (procollagen type 1 amino-terminal propeptide [P1NP]) and resorption (β-cross laps [CTx]) markers. Results: The mean age and body mass index of these children were 11.6 ± 2.3 years (boys: 11.7 ± 2.4; girls: 12.2 ± 1.4 years; p = 0.04) and 18.2 ± 3.9 kg/m2 (boys: 18.1 ± 3.8; girls: 17.8 ± 3.4 kg/m2; p = 0.206), respectively. Baseline serum P1NP levels were positively correlated with serum phosphates (r = 0.281, p < 0.001), PTH (r = 0.291, p < 0.001), and CTx (r = 0.425, p < 0.001) but not with age (r = -0.016, p = 0.404), BMI (r = -0.080, p = 0.032), serum calcium (r = -0.038, p = 0.107), and baseline 25(OH)D (r = -0.069, p = 0.035). Postsupplementation serum P1NP and CTx levels maintained similar correlations. There was a significant decline in serum P1NP (from 681 ± 223 ng/ml to 630 ± 279 ng/ml, p < 0.01) and CTx (from 1.63 ± 0.51 ng/ml to 1.37 ± 0.53 ng/ml, p < 0.01) following supplementation. Though decline in serum P1NP and CTx levels was observed in both boys and girls, among all supplementation patients, the effect was more marked in serum CTx than P1NP levels. Conclusions: Vitamin D supplementation in children resulted in decrease in both bone formation (P1NP) and resorption (CTx). The impact, however, was more marked on bone resorption than bone formation.

Relationship between bone turnover markers and oxidative stress in children with type 1 diabetes mellitus.

Oxidative stress in children with type 1 DM (T1DM) may negatively affect the bone. This study included 40 children with T1DM as the patient group and 40 healthy childrenof matched age and sex as the control group. Plasma alkaline phosphatase, procollagen type-1 amino-terminal propeptide (P1NP), and urinary deoxypyridinoline (DPD) were measured to assess bone turnover. Glutathione, superoxide dismutase (SOD), and malondialdehyde (MDA) were measured to assess oxidative stress. Patients with T1DM had a significantly lower P1NP level but a significantly higher urinary DPD level compared to the control group. Moreover, there were significantly lower glutathione and SOD levels with significantly higher MDA levels in patients with T1DM. We found a significant positive correlation between P1NP level and both glutathione and SOD levels but a significant negative correlation between P1NP and MDA in patients with T1DM. There was a significant negative correlation between DPD levels and both glutathione and SOD levels and a significant positive correlation between DPD and MDA. Moreover, glutathione was a significant predictor for both P1NP and DPD levels, while MDA was a significant predictor for P1NP levels. There is an association between oxidative stress and bone turnover markers in children with T1DM. Oxidative stress can negatively affect bone but the exact relationship between oxidative stress and bone turnover in T1DM has not been previously studied in pediatrics. For the best of our knowledge, our study was the first to assess the relationship between oxidative stress and bone turnover in children with T1DM. We revealed that increased oxidative stress in children and adolescents with T1DM may be involved in the impairment of bone turnover process, so treatment strategies toward better glycemic control and decreasing oxidative stress may be beneficial in preventing and treating diabetic bone disease in these children.

Bone turnover markers in children living with HIV remaining on ritonavir-boosted lopinavir or switching to efavirenz.

We previously found lower bone mass but similar bone turnover in pre-pubertal children living with HIV (CLWH) on a ritonavir-boosted lopinavir (LPV/r)-based vs. efavirenz-based antiretroviral therapy regimen 2years after switch. Here, we evaluate if bone turnover differed between the groups close to the time of switch. Samples from 108 children remaining on LPV/r and 104 children switched to efavirenz were available for analysis 8weeks post-randomization. Bone turnover markers, including C-telopeptide of type 1 collagen (CTx), procollagen type-I N-terminal propeptide (P1NP), and osteocalcin were measured. Markers of immune activation were also measured, including IL-6, TNF-alpha, soluble CD14 and high-sensitivity C-reactive protein (CRP). Eight weeks post-randomization, we did not detect differences in CTx (1.42 vs. 1.44ng/mL, p=0.85) or P1NP concentrations (622 vs. 513ng/mL, p=0.68) between treatment groups. At 8weeks, the treatment groups also had similar levels of IL-6, TNF-alpha, soluble CD14 and high-sensitivity CRP. Osteocalcin (ng/mL) was higher in the LPV/r than efavirenz group both at 8weeks (88.6 vs. 67.3, p=0.001) and 2years (67.6 vs. 49.8, p=0.001). Overall, we failed to detect difference in bone turnover by P1NP and CTx in virologically-suppressed CLWH on different regimens at a time point close to the switch. We did observe higher levels of total osteocalcin in children remaining on LPV/r compared to children switched to efavirenz. Future studies should focus on uncovering the mechanism and determining whether perturbation in undercarboxylated osteocalcin could explain some of the bone side effects noted with protease inhibitors.

Bone turnover markers in children and adolescents with environmentally determined short stature, living in the oil and gas processing region.

In conditions of intensive development of gas fields, environmental safety issues are becoming increasingly important. High rates of gas production and growth of its chemical processing have turned gas industry enterprises into a powerful source of environmental pollution, which poses a real threat to public health and contributes to an increase in morbidities and environmentally determined pathological conditions. The development of methods for the diagnosis, treatment and prevention of such conditions is an important task for modern science. The aim of the research is to make a comprehensive assessment of serum markers of bone synthesis and resorption in children with short stature living in the oil and gas processing regions. A total of 240 children aged 8-17years, living in the oil and gas processing region (Kenkiyak), and 409 schoolchildren (8-17years old), living in the environmentally favourable region (Kobda village), during 3years were examined. It was established that emissions of pollutants by oil processing enterprises account for almost 80% of all emissions into the atmosphere. Gas flaring at oil production sites plays a special role in this process. Speaking of the effects of environmental factors on children's health, it should be noted that there is no consensus on the mechanisms and consequences of exposure to low doses of chemical atmospheric pollutants in children and adolescents so far.

Evaluation of Bone Mineral Density in Children With Hemophilia: An Observational Case-Control Study.

The objectives of this study were to study bone mineral content (BMC), bone mineral density (BMD), vitamin D level, and bone turnover markers in children with hemophilia and compare it with their normal counterparts. This was an observational case-control study. This study was conducted in our tertiary care institute during the period spanning from September 2016 to June 2018. A total of 38 children with hemophilia 2 to 18 years of age and 38 age-matched and sex-matched healthy controls were included. Children with symptomatic hypocalcemia and those receiving drugs affecting BMC and BMD were excluded. Dual-energy x-ray absorptiometry was performed to estimate BMC and BMD. 25-Hydroxyvitamin D [25(OH)D], intact parathormone, osteocalcin, calcium, phosphate and alkaline phosphatase, and spot urine pyrilinks-D/creatinine ratio were estimated in them. BMC and BMD in cases was lower than that in controls (P<0.05). Prevalence of low BMC was seen in 22 (58%) and low BMD in 8 (21%) of cases. All controls had normal BMC and BMD for age. The prevalence of low vitamin D level (<20 ng/mL) was seen in 36 (95%) among cases and in 25 (65%) among controls (P<0.001). Serum phosphorus was lower, and serum alkaline phosphatase was higher in cases than in controls (P<0.05). BMC, BMD, and vitamin D in hemophiliacs were lower than in the general population.

PS1107 IMPACT OF SEVERITY OF THE DISEASE AND FVIII INHIBITOR ON BONE MINERAL DENSITY AND BONE TURNOVER MARKER IN CHILDREN WITH HEMOPHILIA A

Background:Recurrent hemarthroses, and prolonged immobilization may predispose to low bone mineral density in children with hemophilia. Furthermore, adequate dietary calcium intake is a major determinant of bone mass accrual.Aims:To evaluate the impact of severity of the disease and history of FVIII inhibitor on bone density and bone turnover markers in children with hemophilia A.Methods:Children with hemophilia A (severe FVIII: &lt;1 iu/dl, moderate: ≤ 1‐ 5 iu/dl), aged 6–18 years, were evaluated for bone mineral density (BMD) and bone turnover markers. Positive FVIII inhibitor (&gt;0.6 BU, Bethesda units) history was recorded. Patients were categorized into three groups. Group I: severe cases with inhibitor, II: severe cases without inhibitor and III: moderate cases. Dual‐energy X‐Ray absorptiometry (DXA) of total body (TB) and/or lumbar spine (LS) was applied for BMD measurement and expressed as z‐score (low for chronological age, z‐score ≤ ‐2). Bone resorption [urinary deoxypyridinoline/cretinine (uDPD/uCr), urinary excretion of calcium (uCa/uCr), tartrate‐resistant acid phosphatase (Trap)] and bone formation markers [serum total and bone specific alkaline phosphatase (ALP, bALP), osteocalcin and carboxy‐terminal propeptides of type I collagen], as well as vitamin D, parathormone and serum Ca were measured. All patients completed a validated questionnaire about their dietary calcium intake.Results:Fifty one children with hemophilia A (severe 40), mean age: 11.7 ± 3.6 years, were included. Fourteen children (27.4%) had history of FVIII inhibitor. Mean z‐score for LS BMD was −0.51 ± 0.98 [4/40 (10%) had z‐score ≤ ‐2 and 8/40 (20%) had z‐score between −1 and −2)]. Mean z‐score for TB BMD was 0.18 ± 0.85 [none had z‐score ≤ ‐2 and 4/44 (9.1%) had z‐score between −1 and −2)]. Significant difference was found in mean TB and LS BMD between severe and moderate cases (0.81 ± 0.13 vs 0.94 ± 0.18, p = 0.017). Furthermore, hemophilic children with history of inhibitor had lower mean BMD both on TB (0.74 ± 0.069 vs 0.88 ± 0.16, p = 0.005) and LS measurement site (0.66 ± 0.7 vs 0.87 ± 0.24, p = 0.013). Mean TB and LS BMD was significantly higher in group I compared to groups II and III (p &lt; 0.05). On the other hand, patients with severe hemophilia had increased levels of uCa/uCr compared to children with moderate disease (0.35 ± 0.27 vs 0.17 ± 0.08, p &lt; 0.05). In addition, mean value of uDPD/uCr was increased in children with history of inhibitor in comparison to non inhibitor (40.49 ± 11.1 vs 29.09 ± 15.04, p = 0.014). Group I had higher uDPD/uCr values (p &lt; 0.05) compared to group II and group III (40.49 ± 11.1 vs 30.7 ± 16.3 and 24.78 ± 10.54). No differences were observed in other bone markers among all groups. The dietary calcium intake was adequate (&gt; of EAR, Estimated Average Requirement) in only 19% of children, but no differences in both LS and TB BMD were revealed. Nevertheless, children with inadequate calcium intake had significant increased (p &lt; 0.05) ALP/bALP, compared to the rest of patients.Summary/Conclusion:In our study, 10% of children with Haemophilia A had low for chronological age LS BMD. Severe disease and history of FVIII inhibitor seem to burden bone health, as measured with DXA. Resorption markers were found to be impaired. Homeostasis of calcium seem to overweigh low dietary intake. Severe cases, especially those with history of inhibitor, are in higher risk to develop bone metabolic disturbances; thus, close monitoring of bone status seems to be necessitated.

Bone turnover markers in children and adolescents with type 1 diabetes-A systematic review.

Type 1 diabetes (T1D) is associated with impaired bone health and both osteocalcin (OCN) and procollagen type 1 amino terminal propetide (P1NP) (markers of bone formation) and C-terminal cross-linked telopeptide (CTX) (marker of bone resorption) are decreased in adult patients with T1D. We review the existing literature characterizing these bone turnover markers in children and adolescents with T1D and by meta-analysis examine whether alterations in OCN, P1NP, and CTX are evident and if potential changes correlate to the metabolic control (hemoglobin A1c, HbA1c). Systematic searches at MEDLINE and EMBASE were conducted in January 2018 identifying all studies describing OCN, P1NP, or CTX in children and adolescents with T1D. A total of 26 studies were included, representing data from more than 1000 patients with T1D. Pooled analyses of standard mean difference and summary effects analysis were performed when sufficient data were available. Pooled analysis revealed mean OCN to be significantly lower in children and adolescents with T1D compared to healthy controls (standard mean difference: -1.87, 95% confidence interval, CI: -2.83; -0.91) whereas both P1NP and CTX did not differ from the controls. Only data on OCN was sufficient to make pooled correlation analysis revealing a negative correlation between OCN and HbA1c (-0.31 95% CI: -0.45; -0.16). In conclusion, OCN is decreased in children and adolescents with T1D, whether CTX and P1NP are affected as well is unclear, due to very limited data available. New and large studies including OCN, P1NP, and CTX (preferably as z-scores adjusting for age variability) is needed to further elucidate the status of bone turnover in children and adolescents with T1D.

Effect of Vitamin D Supplementation on Bone Turnover Markers in Children and Adolescents from North India.

Objectives:Vitamin D is known to play an important role in bone mineral metabolism. Its deficiency may affect growth and status of bone markers in children. Hence, we undertook to study the status of bone markers in children with vitamin D deficiency (VDD) and impact of vitamin D3 supplementation on them.Materials and Methods:Total 468 out of 615 children and adolescents with VDD, who were given either of the three doses (600, 1000, and 2000) of vitamin D supplementation, were included in the study. These 468 children with pre- and postsupplementation preserved samples with available anthropometry, serum biochemistry, 25-hydroxy-vitamin D, and parathormone were evaluated for bone formation (procollagen type 1 amino-terminal propeptide [P1NP]) and resorption (β-cross laps [CTx]) markers.Results:The mean age and body mass index of these children were 11.3 ± 2.3 years (boys: 11.5 ± 2.4; girls: 12.2 ± 1.2 years; P = 0.03) and 18.1 ± 3.8 kg/m2 (boys: 18.2 ± 3.9; girls: 17.6 ± 3.2 kg/m2; P = 0.208), respectively. There were 8.8% subjects with severe, 42.7% with moderate, and 48.5% with mild VDD. There was a significant decline in serum P1NP (from 691 ± 233 ng/ml to 640 ± 259 ng/ml, P < 0.001) and CTx (from 1.67 ± 0.53 ng/ml to 1.39 ± 0.51 ng/ml, P < 0.001) following supplementation. Though decline in serum P1NP and CTx levels was observed in both boys and girls, among all three supplementation groups and VDD categories, the effect was more marked in serum CTx than P1NP levels.Conclusions:Vitamin D supplementation in VDD children resulted in decrease in both bone formation (P1NP) and resorption (CTx). The impact, however, was more marked on bone resorption than bone formation.

Biochemical bone turnover markers in children and adolescents

Bone is a dynamic tissue that consistently undergoes remodeling. During formation and resorption processes, bone turnover markers are released. They are specific bone-derived molecules that circulate in the blood or are present in the urine reflecting the bone metabolic activity (during childhood and adolescence: bone growth in length, modeling and remodeling). The use of biochemical bone turnover markers provides dynamic indices of bone turnover and complements the static measures of bone, such as measurement of bone mineral density using DEXA or measurement of bone geometry, mass and density using quantitative computed tomography. The assay of bone markers may be repeated at much shorter intervals than remaining measurements so may help in detecting influence of disease or effects of therapy much earlier than changes in bone mass or progression in bone disease can be ascertained. The usefulness of determination of bone turnover markers in children and adolescents requires that the influence of age, sex and pubertal stage be taken into consideration to interpret the results correctly. Bone turnover markers are used in children and adolescents to assess bone metabolic disorders, monitoring disease progression and antiresorptive therapy.

Biochemical bone turnover markers in children and adolescents

Biochemical bone turnover markers in children and adolescents