title: Bone resorption predicts for skeletal complications in metastatic bone disease.
abstract: Relationships between the rate of bone resorption (measured by urinary N-telopeptide (Ntx) excretion) and a range of skeletal complications have been evaluated in patients with metastatic bone disease. A total of 121 patients had monthly measurements of Ntx during treatment with bisphosphonates. All skeletal-related events, plus hospital admissions for bone pain and death during the period of observation, were recorded. Data were available for 121 patients over the first 3-month period of monitoring (0-3 months) and 95 patients over the second 3-month period (4-6 months). N-telopeptide levels were correlated with the number of skeletal-related events and/or death (r=0.62, P<0.001 for 0-3 months and r=0.46, P<0.001 for 4-6 months, respectively). Patients with baseline Ntx values > or =100 nmol mmol(-1) creatinine (representing clearly accelerated bone resorption) were 19.48 times (95% CI 7.55, 50.22) more likely to experience a skeletal-related event/death during the first 3 months than those with Ntx <100 (P<0.001). In a multivariate logistic regression model, Ntx was highly predictive for events/death. This study is the first to indicate a strong correlation between the rate of bone resorption and the frequency of skeletal complications in metastatic bone disease. N-telopeptide appears useful in the prediction of patients most likely to experience skeletal complications and thus benefit from bisphosphonate treatment.
authors.affiliation: Academic Unit of Clinical Oncology, Cancer Research Centre, Weston Park Hospital, Sheffield S10 2SJ, UK.
authors.forename: J E
authors.initials: JE
authors.lastname: Brown
authors.forename: C S
authors.initials: CS
authors.lastname: Thomson
authors.forename: S P
authors.initials: SP
authors.lastname: Ellis
authors.forename: S A
authors.initials: SA
authors.lastname: Gutcher
authors.forename: O P
authors.initials: OP
authors.lastname: Purohit
authors.forename: R E
authors.initials: RE
authors.lastname: Coleman
mesh_terms: D000368:Aged; D015415:Biomarkers; D001847:Bone Diseases / Q000150:complications* / Q000175:diagnosis*; D001859:Bone Neoplasms / Q000150:complications* / Q000556:secondary* / Q000652:urine; D001862:Bone Resorption; D003094:Collagen / Q000652:urine*; D024042:Collagen Type I; D003404:Creatinine / Q000652:urine; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010455:Peptides / Q000652:urine*; D013997:Time Factors
chemical_list: D015415:Biomarkers; D024042:Collagen Type I; D010455:Peptides; C052929:collagen type I trimeric cross-linked peptide; D003094:Collagen; D003404:Creatinine