Reference intervals for CTX and P1NP in a multi-ethnic Malaysian cohort.

BACKGROUND: Well defined reference intervals are central to the utility of serum C-terminal telopeptide of type 1 collagen (CTX) and N-terminal propeptide of type I procollagen (P1NP), designated as reference markers in osteoporosis, and useful for monitoring therapeutic response in that condition. This study reports the reference intervals for plasma CTX and serum P1NP in a multi-ethnic Malaysian population. METHODS: Ethnic Malay, Chinese or Indian subjects aged 45-90 years old were recruited from Selangor, Malaysia from June 2016 to August 2018. Subjects with known medical conditions (e.g., bone disorders, malnutrition, immobilisation, renal impairment, hormonal disorders) and medications (including regular calcium or vitamin D supplements) that may affect CTX and P1NP were excluded. Additionally, subjects with osteoporosis or fracture on imaging studies were excluded. The blood samples were collected between 8 a.m. and 9 a.m. in fasting state. The CTX and P1NP were measured on Roche e411 platform in batches. RESULTS: The 2.5th-97.5th percentiles reference intervals (and bootstrapped 90%CI) for plasma CTX in men (n = 91) were 132 (94-175) - 775 (667-990) ng/L; in post-menopausal women (n = 132) 152 (134-177) - 1025 (834-1293) ng/L. The serum P1NP reference intervals in men were 23.7 (19.1-26.4) - 83.9 (74.0-105.0) µg/L, and in post-menopausal women, 25.9 (19.5-29.3) - 142.1 (104.7-229.7) µg/L. CONCLUSION: The reference intervals for plasma CTX and serum PINP for older Malaysian men and post-menopausal women are somewhat different to other published studies from the region, emphasising the importance of establishing specific reference intervals for each population.

Traditional medicine and food supplements in rheumatic diseases.

This was a prospective survey using a standard questionnaire to determine the prevalence of use of oral traditional medicine and food supplements among patients with rheumatic diseases. Among the 141 patients surveyed, we found that 69% of the patients were consuming food supplements, 35% were using traditional medicine and 45% had used traditional medicine at some time or other. Females were more likely to use food supplements (P < 0017); especially among those with higher education (p < 0.036). There was no statistical difference between those who had ever consumed compared to those who never used traditional medicines. The Chinese were more likely than others to be using traditional medicine (p < 0.007). Vitamin C and B were the most commonly used food supplements. More than two thirds of the patients obtained their traditional medicine from non-medical personnel. More than half of them used 2 or more types of traditional medicine for more than two months. Spending on traditional medicine was noted to be modest with 73% spending less than one hundred ringgit a month for their traditional treatment. Doctors need to be aware of the possible interactions between these 'self-medications' and the conventionally prescribed medication.