Serum Osteocalcin Levels In Patients Research Articles

OSTEOCALCIN ROLE IN THE REGULATION OF INSULIN SECRETION AND OSTEOTROPIC EFFECTS OF DIFFERENT CLASSES OF ANTI-DIABETIC DRUGS (LITERATURE REVIEW AND OWN RESEARCH)

Background. Current data suggest that bone tissue produces hormonally active factors - modulators of metabolic processes throughout the body. The most significant osteoproteins is osteocalcin, the non-collagen structural protein of the bone matrix, which is synthesized by osteoblasts and enters the bloodstream during the resorption of bone tissue. Osteocalcin is involved in the regulation of energy balance, insulin secretion, peripheric insulin sensitivity, and adipocyte’s function, while being an important marker of bone remodeling. The aim of this study was to investigate the relationship between osteocalcin levels and metabolic parameters in 97 patients with type 2 diabetes over 50 years of age, in the course of pharmacotherapy using different classes of antidiabetic drugs, namely human insulin, glucagon-like peptide-1 agonists (aGLP), and sodium-glucose co-transporter 2 (SGLT2) inhibitors, depending on presence of obesity. Results. There was found the highest serum osteocalcin level in patients without obese who received a metabolically active therapy with insulin or aGLP-1, comparing to nonobese subjects of SGLT2 inhibitors therapy group. The lowest level of HbA1c and triglycerides observed in non-obese patients on the background of taking aGLP-1. Conclusion. It can be assumed that the factor determining the hypoglycemic efficacy of investigated drugs may be the pathogenesis of type 2 diabetes which depends on the degree of obesity, while the type of antidiabetic therapy has a corrective effect, probably mediated by changes in body weight and fat distribution.

Bone mineral density and serum osteocalcin levels in patients with gout

ABSTRACTObjective: The objective of the study is to evaluate the relation of gout with osteoporosis and serum osteocalcin (OC) levels.Material and methods: Seventy-five patients diagnosed with gout and 55 controls were included in the study. Comorbid conditions and drugs associated with osteoporosis were excluded. The T and Z scores from lumbar spine (L2–L4) and femur (neck, ward, trochanter, total) were determined by dual-energy X-ray absorptiometry (DXA). OC levels were measured by enzyme-linked immunosorbent assay.Results: Osteoporosis according to T scores of lumbar vertebrae L2–L4 was found to be significantly higher in patients with gout compared to the control group (p = 0.02). Lumbar spine T-score was −1.6 in gout group and −1.0 in controls. OC level was 7.9 ng/mL in the gout group and 18.9 ng/mL in the control group. There was a significant difference (p < 0.001). In addition, mean OC level was 12.4 ± 6.9 ng/mL in the patients diagnosed with osteoporosis and 17.2 ± 10.6 ng/mL in the patients that were classified as normal and a significant difference was established between the two groups (p = 0.03). A significant negative correlation was found between OC level and body mass index, age, and age at first attack. Similarly, femoral T-score established a negative correlation with parathyroid hormone, age, age at first attack, and allopurinol dose.Conclusion: Serum OC level can be a useful marker in the assessment of bone turnover and clinicians should keep osteoporosis in mind in gout patients.

Serum osteocalcin levels in postmenopausal osteoporotic women receiving alendronate

Osteoporosis is characterized by low bone mass, changes in the microscopic structure of bone, and increased bone fragility. Monitoring response to treatment is critical for the appropriate management of osteoporosis. Serum osteocalcin has become known as a bone formation biomarker for the evaluation of treatment response in postmenopausal osteoporosis. The present study assessed the effect of alendronate on serum osteocalcin levels in patients with postmenopausal osteoporosis. Thirty-four women with postmenopausal osteoporosis diagnosed by DEXA received alendronate 10 mg/day for 3 months. Serum osteocalcin, calcium, phosphorus, and alkaline phosphatase (ALP) were measured at baseline and after 45 and 90 days. Mean age and duration of menopause were 57.91±7.68 and 9.37±8.43 years, respectively. Mean serum osteocalcin at baseline was 15.27±3.7 ng/ml, which decreased significantly after 45 and 90 days of treatment with alendronate (p=0.009 and p<0.001, respectively). The levels of serum osteocalcin at days 45 and 90 in patients aged < 60 and ≥ 60 years were not significantly different. The levels of serum osteocalcin at days 45 and 90 in patients with a menopause duration of < 5 and ≥ 5 years were not significantly different. No significant difference was observed in serum osteocalcin levels at days 45 and 90 in patients with osteoporosis only in the femoral neck (n=7), only in the lumbar spine (n=20), and in both femoral neck and lumbar spine (n=7). Measurement of serum osteocalcin is a less expensive, more available tool for monitoring the results of treatment in osteoporotic patients. It provides a practical suggestion about the effectiveness of treatment earlier than densitometry. As expected, osteocalcin levels decreased after treatment of osteoporosis.

CORRELATION OF SERUM OSTEOCALCIN LEVEL AND PERIODONTAL ATTACHMENT LOSS WITH OSTEOPOROSIS RISK STATUS IN POSTMENOPAUSAL WOMEN

Objective: To assess the relationship between serum osteocalcin and periodontal clinical attachment loss (CAL) in postmenopausal women in relation to their osteoporosis risk status.Methods: A cross-sectional study was carried out on 71 postmenopausal women in Kenari District, Central Jakarta, Indonesia. The periodontal examination for all the subjects included a CAL measurement. The serum osteocalcin level was analyzed using ELISA.Results: The correlation between the serum osteocalcin level in patients with CAL and the risk of osteoporosis was analyzed with the Spearman test. The normal group had 29 subjects (40.84%), the osteopenic group had 23 subjects (32.39%), and the osteoporotic group had 19 subjects (26.76%). There was a significant correlation between CAL and the osteoporosis high-risk status (p&lt;0.05) and no significant correlation between the serum osteocalcin level and the osteoporosis status (p&gt;0.05).Conclusion: No correlation was found between CAL and the serum osteocalcin level (p&gt;0.05).

Mitral annular calcification and the serum osteocalcin level in patients with chronic kidney disease

Objective: To determine the relationships between inflammatory mediators, mitral annular calcification (MAC), and osteocalcin in patients with chronic kidney disease (CKD). Materials and methods: Echocardiographic data for 60 patients diagnosed as CKD were retrospectively evaluated. The patients were divided into 2 groups; patients with MAC (MAC+ group) and patients without MAC (MAC− group). The relationships between biochemical markers—including osteocalcin—and MAC were evaluated. Results: The study included 19 female and 41 male patients. In all, 29 patients were MAC+ and 31 were MAC−. High-sensitive C-reactive protein (hsCRP) and osteocalcin levels were significantly higher in the MAC+ group (p < 0.05). The eGFR was lower, serum calcitonin (we could not obtain calcitonin data for 15 patients), Ca, PO4, CaxPO4, the erythrocyte sedimentation rate, red cell distribution width, the neutrophil/Lymphocyte rate, and PTH were higher in the MAC+ group; however, the differences between the groups were not significant (p > 0.05). The mitral E/A ratio, mitral peak Ea velocity, tricuspid E/A ratio, hsCRP, and the osteocalcin level were strongly correlated with MAC. Multivariate logistic regression analysis showed that only the osteocalcin level and mitral E/A ratio were independent variables, each with an independent effect on MAC. Conclusion: CKD patients in the MAC+ group had higher osteocalcin levels than those in the MAC− group, and left ventricular diastolic dysfunction was more common in the MAC+ group.

Serum osteocalcin levels in patients with nonalcoholic fatty liver disease: Association with ballooning degeneration

Our aim was to examine the relation of serum osteocalcin (OCN) levels with the clinical, biochemical, and histological characteristics of patients with biopsy-proven nonalcoholic fatty liver disease (NAFLD). We carried out a case-control study including 99 patients with biopsy-proven NAFLD and 75 age- and sex-matched controls. Concentrations of OCN were measured in aprotinin-treated serum samples using a solid-phase enzyme amplified sensitivity immunoassay. Serum OCN levels were significantly lower in patients with NAFLD than in healthy controls. In patients with NAFLD, serum OCN levels were inversely associated with ALT (r =−0.36, p < 0.001), AST (r =−0.39, p < 0.001), HOMA-IR (r =−0.30, p < 0.01) and the degree of hepatocyte ballooning (r =−0.20, p < 0.05). Serum OCN was the only independent predictor of the degree of hepatocyte ballooning in NAFLD patients (β =−0.24; t = −2.146, p < 0.05). Compared with controls, NAFLD patients have a decrease in serum OCN concentrations, which is significantly associated with serum transaminases and the extent of hepatocyte ballooning.

The relationship between osteoarthritis of the hands, bone mineral density, and bone turnover markers

AimTo investigate the relationship between hand osteoarthritis (HOA), bone mineral density (BMD), and bone turnover markers. MethodsTwenty post-menopausal women aged 50–73years (mean: 62.4±6.5) diagnosed with HOA were recruited along with 10 age-matched post-menopausal women with no signs of HOA as the control group. Both groups had postero-anterior hand radiographs taken and evaluated according to the Kellgren–Lawrence scale to assess OA severity. They underwent thorough clinical examination including measurement of body mass index (BMI). They completed the AUSCAN questionnaire. Grip strength was measured using a hand held dynamometer and lateral pinch strength was measured using a pinchmeter. They underwent BMD measurement at the hip and wrist using Dual energy X-ray absorptiometry. Furthermore, they had serum osteocalcin and urinary deoxypyridinoline (DPD) measured. ResultsThere was no statistically significant difference in T-scores of the hip (P=0.168) and wrist (P=0.45) between the patients and the controls. However, six patients (30%) had osteoporosis. A total of 12 patients had diminished BMD at the hip. There was no significant increase in serum osteocalcin levels in patients compared to controls (P=0.382). However, urinary DPD was significantly elevated in the patient group compared to the controls, (P<0.0001). There was a positive correlation between T-scores at the hip and BMI (P=0.017). There was a negative correlation of T-scores at the hip and wrist with postmenopausal duration and parity. There was no correlation between the T-scores and bone turnover markers. There was a positive correlation between OA severity and both T and Z-scores at the wrist. ConclusionsAlthough there was no significant association between HOA and BMD, HOA is associated with increased bone turnover as demonstrated by the significant elevation in urinary DPD. These patients should be followed up to assess the need for medical treatment to prevent future fractures.

Once Weekly Bortezomib (Velcade) Preserves Bone Health by a Direct Effect on Osteoclast Function Independent of Its Effect on the Malignant Plasma Cells.

Bone resorption is increased in multiple myeloma (MM) due to increased osteoclast activity leading to osteoporosis and osteolytic bone lesions. Assays of urinary excretion of N-telopeptide (NTX), a highly specific marker of bone resorption, decrease by 20–70% following treatment with bisphosphonates. Receptor activator of NF-kB (RANK) ligand increases osteoclast mediated bone resorption in part through activation of nuclear factor kappa-B(NF-kB). Preclinical studies have shown bortezomib to decrease osteoclast function through inhibition of NF-kB. However, no clinical data exists on the effect of bortezomib on markers of bone resorption. We designed a prospective clinical trial aimed at measuring the effect of bortezomib on urinary NTX excretion and serum osteocalcin levels in patients with MM. Patients received six cycles of consolidation bortezomib 1.3mg/m2 given once weekly (for ease of administration) for 4 of every 5 weeks, 90–120 days post transplant. Urinary NTX excretion and serum osteocalcin were measured on day 1 of cycles 1, 2 and 3 of therapy. Treatment with bisphosphonates was prohibited from 42 days prior to stem cell collection and until cycle 3 of post transplant bortezomib therapy. To date, 31 of 40 enrolled patients have proceeded to receive bortezomib consolidation therapy and are evaluable for markers of bone metabolism. Characteristics of the patient population and disease include (no. of patients): male (21), female (10), median age 56 years (range 39–70), Stage II (8), Stage III (23), IgG (20), IgA (9), free light chain (2). The median duration between discontinuation of prior bisphosphonate therapy and initiation of post transplantation weekly bortezomib was 158 days (Range 132–196). Of the 19 patients who have completed all 6 prescribed cycles of consolidation bortezomib, only one patient has had a 50% or greater reduction in paraprotein, 16 had stable disease and 2 had disease progression. Nevertheless, excretion of NTX decreased by a mean of 7.4 nmol/mmol creatinine over each 5 week treatment cycle (p=0.007) with a mean decline of 33% over baseline values after 2 cycles of consolidation, once weekly bortezomib therapy (see table). Only one patient displayed an increase in urinary NTX of greater than 30%. This was the only patient with evidence of disease progression during this period of consolidation. Contrary to preclinical and clinical reports of proteasome inhibition resulting in increased osteoblastic bone formation, a decrease was seen in serum osteocalcin. This data suggests that bortezomib, given just once weekly, has a substantial inhibitory effect on osteoclastic bone resorption in MM even in the absence of effects on the malignant plasma cells. The magnitude of effect appears comparable to that achieved with bisphosphonates. Given concerns regarding long term toxicities of bisphosphonate therapy, including nephrotoxicity and osteonecrosis of the jaw, bortezomib may represent an alternative agent effective in controlling both the myeloma and bone disease in this patient population.Cycle 1 Day 1Cycle 2 Day 1Cycle 3 Day 1Mean Changep valueMean Osteocalcin (Range)(ng/ml)28.16 (9.30 – 81.90) (n = 28)26.69 (9.50 – 57.40) (n = 25)26.12 (11.60 – 73.00) (n = 21)−4.6 (16%)0.02Mean NTX excretion (Range)(nmol/mmol Cr)44.87 (10 – 121) (n = 23)36.00 (7 – 65) (n = 24)30.43 (9 – 87) (n = 21)−14.8 (33%)0.007

Urinary excretion of pyridinium cross-links and serum osteocalcin levels in patients with primary high-grade osteosarcoma.

Osteosarcoma is the most frequent primary high grade bone tumor, usually occurring in adolescents and children. The aim of the present study was to investigate parameters of bone turnover as urinary excretion of pyridinoline (Pyr), and deoxypyridinoline (D-Pyr), serum osteocalcin (OC), and total alkaline phosphatase (AP) in patients with osteosarcoma. Thirty-five patients aged 7-22 (median age 14) with primary high-grade osteosarcoma of the extremity entered the study. A control population of age- and sex-matched healthy individuals was studied. Urinary excretion of Pyr, D-Pyr was measured on fasting urine specimens, corrected for creatine excretion (Ucr), and expressed as pM/microM UCr. At the same time as urine collection, blood samples were taken for measurement of AP and OC. In patients with osteosarcoma the urinary excretion of D-Pyr (74.5 +/- 41) was significantly higher (P = 0.005) than in controls (38.2 +/- 22.5). The serum level of OC was significantly lower (P < 0.001) in patients with osteosarcoma than in controls. Moreover, significantly (P = 0.03) higher excretion of D-Pyr (85.3 +/- 43) was found in patients who relapsed after surgical removal of the tumor and chemotherapeutic treatment compared with those (58.1 +/- 22) who remained continuously free of disease. The present study showed significant abnormalities of urinary excretion of pyridinium crosslinks and serum OC level in patients with osteosarcoma. The relation between urinary excretion of D-Pyr and biological tumor aggressiveness observed in the present study requires further investigation.

Serum osteocalcin levels in patients with psoriatic arthritis: an extended report.

The aim of the study was to investigate the rate of bone formation in patients with psoriatic arthritis (PsA) compared to controls and patients with psoriasis vulgaris without PsA (PS). Osteocalcin (OC) and other parameters of bone turnover were measured in 32 patients with PsA and 17 patients with PS and compared to controls (n = 50). Patients with PsA do not generally present with different OC levels (3.0 +/- 1.6 ng/ml), than controls (3.6 +/- 1.17 ng/ml), if disease activity or sex are not considered. Women with PsA had significantly lower OC levels (2.28 +/- 0.44 ng/ml) than female controls (4.11 +/- 1.7 ng/ml) or women with PS (3.0 +/- 0.89 ng/ml). However, mean disease activity (2.27 +/- 1.0 vs 2.95 +/- 0.92) was also significantly lower in women than men. Furthermore, we found a significant correlation between alkaline phosphatase (AP) and OC in all patients with PsA (r = 0.49, P < 0.05). Disease activity of PsA had an influence on OC levels. Patients with no disease activity had lower OC levels (2.2 +/- 0.7 ng/ml) than patients with a high activity (OC 3.92 +/- 1.25, P < 0.05). Similar results were obtained with alkaline phosphatase. In addition, we found a significant correlation between clinical activity and OC (r = 0.38, P < 0.02) and alkaline phosphatase (r = 0.49, P < 0.01). Patients with PsA show a corresponding increase in OC levels. if disease activity is high. The proliferative changes in active PsA may be related to inflammatory mechanisms coupled with bone formation.

Osteodystrophy in patients with chronic hepatitis and liver cirrhosis.

Bone mineral density (BMD) of the lumber vertebrae and factors related to bone metabolism were determined in patients with chronic viral hepatitis and patients with liver cirrhosis to clarify correlations between hepatic dysfunction, considered to be one of the causes of hepatic osteodystrophy, and decrease in bone mass. BMD of the second to fourth lumbar vertebrae was determined with a Lunar (Madison, WI, USA) DPX, a dual-energy X-ray absorptiometry diagnostic system. BMD was significantly lowest in patients with liver cirrhosis, followed by patients with chronic hepatitis, and healthy subjects, in this order. There was a significantly positive but weak correlation between albumin and BMD. Levels of 25(OH)D and 1,25(OH)2D were significantly lower in patients with liver cirrhosis than in those with chronic hepatitis. BMD and vitamin D were decreased in all patients whose cholinesterase (ChE) was below 0.3 delta pH. Urinary pyridinoline (Upyr) was significantly higher in the patients with liver cirrhosis, in whom bone mass was decreased, than in the patients with chronic hepatitis, whereas serum osteocalcin levels were distributed in the upper normal range in patients with chronic hepatitis and those with liver cirrhosis. There was a positive correlation between 25(OH)D and serum osteocalcin levels in patients with liver cirrhosis. These results indicate that osteogenesis is decreased and suggest that the decrease in BMD which occurs in viral liver cirrhosis, probably related to decreased, bone formation and slight promotion of bone resorption, reflects deranged hepatic function. This is the first report of Upyr and urinary deoxypyridinoline (UDpyr) determination in patients with liver cirrhosis and patients with chronic hepatitis. The negative correlation of Upyr and UDpyr with ChE is a novel finding.

Cyclosporin A increases the biochemical markers of bone remodeling in primary biliary cirrhosis

To assess whether cyclosporin A has any influence on the bones of patients with primary biliary cirrhosis, bone mineral density, vertebral fractures and biochemical and hormonal parameters of bone mineral metabolism were evaluated in 38 female patients with primary biliary cirrhosis who, 7 to 47 months previously, had been randomized to receive cyclosporin A (n = 18) or placebo (n = 20). Bone mineral density and vertebral fractures were reevaluated after 12 to 47 months in 19 of these patients (ten with cyclosporin and nine with placebo). Serum osteocalcin levels in patients taking cyclosporin (median, range: 7.8, 4.2-16 ng/ml) were similar to healthy female controls (6.0, 4.7-9.5 ng/ml), and significantly higher than in patients receiving placebo (5.4, 1.0-8.6 ng/ml, p < 0.02). Patients treated with cyclosporin showed a higher urinary hydroxyproline/creatinine ratio (0.097, 0.025-0.138) than patients with placebo (0.031, 0.022-0.044) (0.05 > p < 0.1), and healthy controls (0.032, 0.021-0.048) (p < 0.001). Urinary hydroxyproline was above normal levels in six of nine patients treated with cyclosporin. Circulating parathyroid hormone levels were also higher in patients treated with cyclosporin (4.3, 2.0-9.0 pmol/l) than in those with placebo (3.1, 1.1-5.1 pmol/l) (p < 0.001), and healthy controls (2.9, 1.1-6.9 pmol/l) (p < 0.001). In four patients treated with cyclosporin the parathyroid hormone levels were above normal values. No patient had renal failure.(ABSTRACT TRUNCATED AT 250 WORDS)

Increased serum osteocalcin levels in patients with paraplegia.

Osteocalcin(OC) is a specific serum parameter of bone formation. Since bone metabolism disturbances, including osteoporosis, are seen in paraplegia, the serum levels of OC, midregional parathyroid hormone(mPTH), intact para-thyroid hormone (iPTH) and calcitonin (CT) serum levels were determined in 13 patients with paraplegia or tetraplegia and 15 control subjects by radioimmunoassay in a cross sectional study. In addition, the urinary hydroxyproline/creatine and the urinary calcium/creatinine ratio was determined. Serum OC levels were significantly increased in the patients with spinal cord injury (p less than 0.02), whereas serum levels of mPTH, iPTH and CT were not statistically different. The urinary hydroxyproline/creatinine ratio was significantly higher in the patients than in the controls (p less than 0.02), and the urinary calcium/creatinine ratio also tended to be higher in the patients. In a follow up study over 6 months after spinal cord injury, serum OC, serum iPTH, urinary hydroxyproline/creatinine ratio and the calcium/creatinine ratio were determined in 6 patients at monthly intervals. Hyperhydroxyprolinuria preceded the gradual increase of serum OC from normal to clearly elevated levels. Our data suggest that increased bone resorption in paraplegia is linked to an enhanced osteoblastic activity.

Serum Osteocalcin in Patients Takingl-Thyroxine who Have Subclinical Hyperthyroidism*

Serum osteocalcin, an index of osteoblastic activity, is increased in hyperthyroidism. Serum osteocalcin levels are negatively correlated with bone density in patients with overt hyperthyroidism. Osteocalcin levels are also elevated in patients with multinodular goiter and subclinical hyperthyroidism. We therefore measured serum osteocalcin levels in patients taking T4 to determine if they correlated with the degree of TSH suppression. Despite an upward trend in serum osteocalcin measurements with decreasing TSH concentrations, there was no significant difference in serum osteocalcin among groups of patients with normal (0.5-5.0 mu/L), mildly reduced (0.1-0.5 mU/L), or undetectable serum TSH (less than 0.01 mU/L). However, a weak negative correlation was seen between serum TSH and osteocalcin concentrations (r = 0.29, slope = -0.28, P less than 0.05). Osteocalcin did not correlate with either serum free T4 or free T3 concentrations. Serum PTH concentrations were not different among the three patient groups. Our data suggest that osteocalcin is not a useful clinical marker for increased bone turnover in patients with subclinical hyperthyroidism due to T4 therapy. However, the trend towards higher osteocalcin levels in patients with suppressed serum TSH values, and the weak negative correlation between serum TSH and osteocalcin are consistent with findings of reduced bone density in these patients.

Serum Osteocalcin Levels in Patients with GH Deficiency before and during GH Treatment

Serum Osteocalcin Levels in Patients with GH Deficiency before and during GH Treatment

Decreased serum osteocalcin levels in patients with liver cirrhosis

Serum levels of osteocalcin (OC) have been found to be a specific biochemical parameter of bone formation. We measured serum levels of osteocalcin, parathyroid hormone (PTH) and 25-hydroxyvitamin D (25(OH)D) in 49 patients with liver cirrhosis, who are known to have an increased prevalence of metabolic bone disease, and a matched control group ( n = 35). Serum levels of OC were significantly decreased in the patients with liver cirrhosis when compared to control subjects ( P < 0.001). Serum levels of 25(OH)D were decreased ( P < 0.001), whereas no statistical difference was found between the serum levels of PTH in the patients with liver cirrhosis and those of the controls. In a subgroup of 23 patients with cirrhosis of the liver and 34 control subjects, the bone mineral content (BMC) of the non-dominant forearm was determined by single photon absorptiometry. BMC was significantly lower in the patient with liver cirrhosis than the control subjects ( P < 0.04). Our data demonstrate vitamin D deficiency, decreased bone formation and a decreased BMC in patients with liver cirrhosis.

Decreased serum osteocalcin level in patients with alcoholic and nonalcoholic chronic liver disease

Decreased serum osteocalcin level in patients with alcoholic and nonalcoholic chronic liver disease