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Biochemical markers of bone turnover
P M Crofton1, H F Stirling, E Schönau
1Department of Paediatric Biochemistry, Royal Hospital for Sick Children, Edinburgh, UK.
Insights
Bone turnover markers, including procollagen type I C-terminal propeptide and bone alkaline phosphatase (BALP), effectively track growth in children. These markers reveal changes during growth hormone therapy, chemotherapy, and corticosteroid treatment.
Area of Science:
- Pediatrics
- Endocrinology
- Biochemistry
Background:
- Assessing bone turnover and growth in children is crucial for monitoring development and treatment efficacy.
- Biochemical markers offer a non-invasive method to evaluate bone metabolism.
- Existing methods may not fully capture dynamic changes in pediatric bone health.
Purpose of the Study:
- To evaluate the utility of procollagen type I C-terminal propeptide, type I collagen cross-linked telopeptide, and bone alkaline phosphatase (BALP) in assessing pediatric bone turnover and growth.
- To correlate changes in BALP with height velocity in children treated with growth hormone.
- To examine the impact of chemotherapy and corticosteroid treatment on bone metabolism markers in children.
Main Methods:
- Study 1: Assessed 50 short normal children treated with growth hormone or placebo, measuring delta BALP and height velocity.
- Study 2: Monitored 12 children with acute lymphoblastic leukemia during chemotherapy, analyzing collagen peptides, BALP, and leg length velocity.
- Study 3: Compared 14 premature infants treated with high-dose dexamethasone to 25 non-steroid-treated infants, measuring collagen peptides, weight, and leg length.
Main Results:
- In growth hormone-treated children, delta BALP strongly correlated with height velocity response.
- Chemotherapy in leukemia patients induced significant changes in bone markers and growth velocity, with suppression and catch-up phases.
- Dexamethasone treatment in infants led to rapid decreases in collagen peptides, weight loss, and leg shrinkage, followed by recovery during steroid weaning.
Conclusions:
- Procollagen type I C-terminal propeptide and BALP are valuable tools for monitoring bone turnover and growth responses in pediatric patients undergoing various treatments.
- These markers can detect significant alterations in bone metabolism during growth hormone therapy, chemotherapy, and corticosteroid administration.
- The findings support the use of these biochemical markers for personalized pediatric care and treatment adjustments.
Abstract:
Three studies to evaluate procollagen type I C-terminal propeptide, type I collagen cross-linked telopeptide and bone alkaline phosphatase (BALP) in the assessment of bone turnover and growth in children are presented. (1) In 50 short normal children treated with placebo or growth hormone, delta BALP after 3 months of treatment was highly correlated with height velocity response after 1 year (r = 0.67, p < 0.0001). (2) In 12 children with acute lymphoblastic leukaemia, marked changes in collagen peptides, BALP, and lower leg length velocity were seen during the first 6 months of chemotherapy. Suppression occurred during induction and the two intensification phases, with catch-up during the intervening phase (paired t-tests, p < 0.001). (3) Fourteen babies (birthweight < 1,500 g) treated with high-dose dexamethasone for bronchopulmonary dysplasia were compared with 25 non-steroid-treated babies < 1,500 g. Both collagen peptides decreased rapidly and dramatically (mean decreases 41-68%) after dexamethasone was started, accompanied by weight loss and lower leg shrinkage and followed by recovery during steroid weaning.