title: Bone turnover markers in women with early stage breast cancer who developed bone metastases. A prospective study with multivariate logistic regression analysis of accuracy.
abstract: BACKGROUND
  The skeleton is the most common site of metastasis for breast cancer and the periodic measurement of circulating bone turnover markers (BTMs) can be useful. The aim of this study was to prospectively evaluate the diagnostic accuracy of a panel of BTMs in the early detection of bone metastases (BMs).
  
  
  METHODS
  We reviewed the medical records of 297 postmenopausal women with early stage luminal-type invasive ductal carcinoma (IDC). Twenty-six patients who developed isolated BMs during follow-up and 24 randomly selected controls were studied. The two groups were matched according to age, final disease staging, and follow-up. All patients underwent periodic measurement of total and bone-specific (BSAP) alkaline phosphatase, CTX, ICTP, osteocalcin, NTX, PINP, and TRACP5b.
  
  
  RESULTS
  Only BSAP, CTX, PINP, and TRACP5b were significantly (p<0.05) associated with the group, and the logistic regression analysis excluded CTX from the model. The AUC (ROC curve) for TRACP5b alone, which was the most accurate marker, and for the combination of BSAP+PINP+TRACP5b was 0.784 (95% CI: 0.651-0.916) and 0.889 (95% CI: 0.798-0.981), respectively.
  
  
  CONCLUSIONS
  According to our results, the measurement of these three markers together should be performed in all postmenopausal patients with luminal-type IDC, when an early diagnosis of BMs is required.
authors.affiliation: Department of Surgery, Oncology & Gastroenterology (DiSCOG), University of Padua, School of Medicine, 35128 Padova, Italy. Electronic address: flumachi@unipd.it.
authors.forename: Franco
authors.initials: F
authors.lastname: Lumachi
authors.affiliation: Department of Surgery, General Surgery, S. Maria degli Angeli Hospital, 33170 Pordenone, Italy.
authors.forename: Stefano M M
authors.initials: SM
authors.lastname: Basso
authors.affiliation: Department of Medicine (DiMed), University of Padua, School of Medicine, 35128 Padova, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Camozzi
authors.affiliation: Department of Laboratory Medicine, Clinical Pathology Laboratory, S. Maria degli Angeli Hospital, 33170 Pordenone, Italy.
authors.forename: Renato
authors.initials: R
authors.lastname: Tozzoli
authors.affiliation: Department of Diagnostic Imaging, Nuclear Medicine Section, S. Maria degli Angeli Hospital, 33170 Pordenone, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Spaziante
authors.affiliation: Department of Neurosciences (DNS), University of Padua, School of Medicine, 35128 Padova, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Ermani
mesh_terms: D000368:Aged; D000469:Alkaline Phosphatase / Q000032:analysis; D014408:Biomarkers, Tumor / Q000032:analysis; D001859:Bone Neoplasms / Q000175:diagnosis / Q000556:secondary*; D016723:Bone Remodeling; D001943:Breast Neoplasms / Q000473:pathology*; D018270:Carcinoma, Ductal, Breast / Q000473:pathology; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D010446:Peptide Fragments / Q000032:analysis; D017698:Postmenopause; D011347:Procollagen / Q000032:analysis; D011446:Prospective Studies; D000071681:Tartrate-Resistant Acid Phosphatase / Q000032:analysis
chemical_list: D014408:Biomarkers, Tumor; D010446:Peptide Fragments; D011347:Procollagen; C047202:procollagen Type I N-terminal peptide; D000469:Alkaline Phosphatase; C000605510:ACP5 protein, human; D000071681:Tartrate-Resistant Acid Phosphatase
keywords: Alkaline phosphatase; Bone markers; Bone metastases; Breast cancer; PINP; TRACP5b