title: Improved assessment of bone turnover by the PTH-(1-84)/large C-PTH fragments ratio in ESRD patients.
abstract: BACKGROUND
  The "intact" parathyroid hormone (PTH) assay recognizes PTH-(1-84) as well as amino terminally truncated PTH fragments, that is, large carboxyterminal PTH fragments (C-PTH fragments). The present study investigated whether the use of the plasma PTH-(1-84)/C-PTH fragment ratio enhances the noninvasive assessment of bone turnover in patients on dialysis.
  
  
  METHODS
  Bone biopsies and blood samples for determinations of routine indices of bone turnover and PTH peptides were obtained in 51 adult patients on dialysis not treated with drugs affecting bone such as vitamin D or corticosteroids. Blood levels of large C-PTH fragments were calculated by subtracting PTH-(1-84) from "intact" PTH. Patients were classified according to their levels of bone turnover based on histomorphometrically obtained results of activation frequency. Prediction of bone turnover by the various blood indices was done by using proper statistical methods. In addition, hypercalcemia was induced by calcium gluconate infusion in a subset of patients, and levels of PTH-(1-84), "intact" PTH, and PTH-(1-84)/C-PTH fragment ratio were determined.
  
  
  RESULTS
  The PTH-(1-84)/C-PTH fragment ratio was the best predictor of bone turnover. A ratio> 1 predicted high or normal bone turnover (sensitivity 100%), whereas a ratio <1 indicated a high probability (sensitivity 87.5%) of low bone turnover. Calcium infusion resulted in decrease in PTH-(1-84)/C-PTH fragment ratio.
  
  
  CONCLUSIONS
  The PTH-(1-84)/C-PTH fragment ratio predicts bone turnover with acceptable precision for biological measurements. Moreover, a change in serum calcium levels is one of the regulators of the relative amount of circulating PTH-(1-84) and its large C-PTH fragments.
authors.affiliation: Division of Nephrology, Bone and Mineral Metabolism, Department of Internal Medicine, University of Kentucky, Lexington, Kentucky, USA.
authors.forename: M C
authors.initials: MC
authors.lastname: Monier-Faugere
authors.forename: Z
authors.initials: Z
authors.lastname: Geng
authors.forename: H
authors.initials: H
authors.lastname: Mawad
authors.forename: R M
authors.initials: RM
authors.lastname: Friedler
authors.forename: P
authors.initials: P
authors.lastname: Gao
authors.forename: T L
authors.initials: TL
authors.lastname: Cantor
authors.forename: H H
authors.initials: HH
authors.lastname: Malluche
mesh_terms: D000328:Adult; D016723:Bone Remodeling / Q000502:physiology*; D005260:Female; D005544:Forecasting; D006801:Humans; D006934:Hypercalcemia / Q000097:blood; D007676:Kidney Failure, Chronic / Q000097:blood / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*
chemical_list: D010281:Parathyroid Hormone; D010446:Peptide Fragments