Concordance between direct and indirect measurements of free 25-OH vitamin D.

At present, data comparing the quantification methods for measurement of free vitamin D (direct assay [direct 25-OHDF] and estimated by calculation [calculated 25-OHDF]), are scarce. The aim of this study was to analyse the concordance between these two methods of 25-OHDF analysis (direct vs. calculated). METHODS: Serum values of total 25-OHD (25-OHDT), vitamin D binding protein (DBP) (by R&D Systems ELISA), calculated 25-OHDF (by DBP, albumin and 25-OHDT) and direct 25-OHDF (by DIAsource ELISA) were analysed in 173 healthy women (aged 35-45years). Assessment of concordance was evaluated by the Bland-Altman plot and the total deviation index (TDI). RESULTS: The mean values of calculated and direct 25-OHDF in these subjects were 5.27±2.5 and 3.83±1.01pg/mL, respectively. We found significantly lower values of 25-OHDF on comparing subjects with and without vitamin D deficiency, independently of the method used. The total deviation index evaluated by the Bland-Altman plot showed low concordance for both measurements. Only low 25-OHDF levels were concordant. CONCLUSIONS: This study shows that the concordance between these two methods of 25-OHDF analysis is low and has a concentration dependent bias. Further studies are necessary to clarify the reference values and the indications for 25-OHDF measurement.

Reference intervals for bone turnover markers in Spanish premenopausal women.

BACKGROUND: The aims of this study were to establish robust reference intervals and to investigate the factors influencing bone turnover markers (BTMs) in healthy premenopausal Spanish women. METHODS: A total of 184 women (35-45 years) from 13 centers in Catalonia were analyzed. Blood and second void urine samples were collected between 8 a.m. and 10 a.m. after an overnight fast. Serum procollagen type I amino-terminal propeptide (PINP) and serum cross-linked C-terminal telopeptide of type I collagen (CTX-I) were measured by two automated assays (Roche and IDS), bone alkaline phosphatase (bone ALP) by ELISA, osteocalcin (OC) by IRMA and urinary NTX-I by ELISA. PTH and 25-hydroxyvitamin D (25OHD) levels were measured. All participants completed a questionnaire on lifestyle factors. RESULTS: Reference intervals were: PINP: 22.7-63.1 and 21.8-65.5 µg/L, bone ALP: 6.0-13.6 µg/L, OC: 8.0-23.0 µg/L, CTX-I: 137-484 and 109-544 ng/L and NTX-I: 19.6-68.9 nM/mM. Oral contraceptive pills (OCPs) influenced PINP (p=0.007), and low body mass index (BMI) was associated with higher BTMs except for bone ALP. Women under 40 had higher median values of most BTMs. CTX-I was influenced by calcium intake (p=0.010) and PTH (p=0.007). 25OHD levels did not influence BTMs. Concordance between the two automated assays for PINP and particularly CTX-I was poor. CONCLUSIONS: Robust reference intervals for BTMs in a Southern European country are provided. The effects of OCPs and BMI on their levels are significant, whilst serum 25OHD levels did not influence BTMs. Age, calcium intake, BMI and PTH influenced CTX-I. The two automated assays for measuring PINP and CTX-I are not interchangeable.

Arteritis temporal con velocidad de sedimentación globular normal / Temporal arteritis with normal erythrocyte sedimentation rate

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Distribution of serum ßCTX in a population-based study of postmenopausal women taking into account different anti-osteoporotic therapies (the FRODOS Cohort).

This cross-sectional study evaluated the distribution of serum cross-linked C-telopeptides of collagen type I (ßCTXs) in postmenopausal women, the characteristics of bone remodeling, and the factors influencing this bone marker, especially the use of anti-osteoporotic drugs. Women (n = 4,175) aged 59-70 years randomly selected from the community were invited to participate, measuring ßCTXs and lumbar and femoral bone mineral density at recruitment. Risk factors for osteoporosis and the use of anti-osteoporotic treatment were collected with a structured questionnaire. We evaluated the percentage of women with increased (ßCTXs >0.620 ng/mL) and decreased bone turnover (ßCTXs <0.100 ng/mL) and those reaching the so-called treatment target (values of ßCTXs within the lower half of the reference range for healthy young premenopausal women). Two thousand nine hundred sixty-eight women (70 %) participated (2,405 non-treated and 563 treated). Increased and decreased bone turnover was observed in 16.4 and 1.8 %, respectively, of non-treated women with significant differences compared with treated women (9.7 and 14.2 %, respectively, p < 0.001); 28 % of non-treated osteoporotic individuals had increased bone turnover versus 14 % of osteopenic participants and 8.8 % of women with normal bone density (p < 0.001). Women receiving bisphosphonates presented the highest percentages of decreased bone turnover (27 %) and ßCTXs (43 %) within the treatment target. Increased bone turnover is observed in 16.4 % of non-treated postmenopausal women and is more frequent in individuals with osteoporosis, whereas decreased bone turnover is unusual. Most participants taking bisphosphonates had values within the treatment target, but nearly one quarter had decreased bone turnover.

Relación del telopéptido carboxiterminal del colágeno tipo I sérico con la densidad mineral ósea y el consumo de fármacos en mujeres posmenopáusicas. Datos preliminares del estudio FRODOS / Relationship between C-telopeptides of type I collagen serum values with bone mineral density and antiosteoporotic drug intake in postmenopausal women. Preliminary data from the FRODOS study

Fundamento y objetivo: El estudio de los marcadores del recambio óseo se ha abordado en series limitadas de mujeres posmenopáusicas. Los objetivos del trabajo fueron estudiar la relación del telopéptido carboxiterminal del colágeno tipo I sérico (βCTXs) con la densidad mineral ósea (DMO) y con el consumo de fármacos antiosteoporóticos en una amplia población de mujeres posmenopáusicas. Pacientes y método: Se estudiaron 1.495 mujeres seleccionadas aleatorizadamente de la población general de 59–70 años (con una media de 15,7 años de menopausia) dentro de la fase transversal de un estudio de cohorte. Se determinó el βCTXs en ayunas, se realizó una densitometría ósea y una encuesta clinicoepidemiológica con registro de consumo de fármacos. Resultados: El 26% de las participantes tenía osteoporosis por densitometría y el 18% consumía fármacos contra la osteoporosis. En las mujeres no tratadas con fármacos antiosteoporóticos los valores de βCTXs fueron superiores en las participantes con osteoporosis y osteopenia frente a aquéllas con DMO normal (p<0,05). En las mujeres tratadas, el βCTXs fue significativamente menor y con valores similares a los premenopáusicos. Conclusiones: En la población estudiada de mujeres posmenopáusicas no seleccionadas, los valores de βCTXs se asocian a las categorías de DMO y muestran un descenso marcado por el consumo de fármacos antiosteoporóticos (AU)

Background and objective: Few studies have addressed the role of bone turnover markers (BTM) in Spanish postmenopausal women. The goal of the study was to analyse the relationship between crosslinked C-telopeptides of type I collagen (βCTXs) serum values and bone mineral density (BMD) and antiosteoporotic drug intake in a large sample of postmenopausal women.Patients and method: We have recruited 1495 women aged 59–70 years (15,7 years since menopause) randomly selected from the general population within the cross-sectional phase of a cohort study. All participants had undergone βCTXs testing in fast state, BMD scan of spine and femur (WHO classification) and a clinic-epidemiological questionnaire with specific drug intake record. Results:Twenty-six (26) % of the participants had osteoporosis and 18% took antiosteoporotic drugs. In women who did not receive antiosteoporotic drugs, βCTXs was higher in participants with osteoporosis and osteopenia when compared with those with normal BMD (p<0,05). In women under therapy, βCTXs was significantly lower compared with women with no therapy and the mean values were similar to those of premenopausal women. Conclusions:In this group of unselected postmenopausal women, βCTXs values are associated with BMD categories and showed a marked decrease in those taking antiosteoporotic drugs (AU)

[Relationship between C-telopeptides of type I collagen serum values with bone mineral density and antiosteoporotic drug intake in postmenopausal women. Preliminary data from the FRODOS study]. / Relación del telopéptido carboxiterminal del colágeno tipo I sérico con la densidad mineral ósea y el consumo de fármacos en mujeres posmenopáusicas. Datos preliminares del estudio FRODOS.

BACKGROUND AND OBJECTIVE: Few studies have addressed the role of bone turnover markers (BTM) in Spanish postmenopausal women. The goal of the study was to analyse the relationship between crosslinked C-telopeptides of type I collagen (betaCTXs) serum values and bone mineral density (BMD) and antiosteoporotic drug intake in a large sample of postmenopausal women. PATIENTS AND METHOD: We have recruited 1495 women aged 59-70 years (15.7 years since menopause) randomly selected from the general population within the cross-sectional phase of a cohort study. All participants had undergone betaCTXs testing in fast state, BMD scan of spine and femur (WHO classification) and a clinic-epidemiological questionnaire with specific drug intake record. RESULTS: Twenty-six (26) % of the participants had osteoporosis and 18% took antiosteoporotic drugs. In women who did not receive antiosteoporotic drugs, betaCTXs was higher in participants with osteoporosis and osteopenia when compared with those with normal BMD (p < 0.05). In women under therapy, betaCTXs was significantly lower compared with women with no therapy and the mean values were similar to those of premenopausal women. CONCLUSIONS: In this group of unselected postmenopausal women, betaCTXs values are associated with BMD categories and showed a marked decrease in those taking antiosteoporotic drugs.

Macroscopic features of knee synovitis in early untreated Behçet disease and psoriatic arthritis.

In a previous study, we found that synovial immunopathology differs between Behçet disease (BD) and psoriatic arthritis (PsA). The objective of this study is to describe the macroscopic features of early untreated knee synovitis in BD and PsA. Fourteen consecutive patients with active early knee synovitis (seven BD and seven PsA) undergoing rheumatologic arthroscopy were assessed. The following macroscopic synovial features were evaluated and scored by analyzing the video recordings of each procedure: capillary hyperaemia, morphology of synovitis, vascular pattern, fibrinoid membranes, and topographic distribution of these features. Video-recording of 35 early untreated arthritis patients with different diagnoses were also studied looking for BD-like macroscopic features. Six out of seven BD patients had extensive fibrinoid membranes and large areas of erythematous synovitis without villi or a distinctive vascular pattern, while PsA patients had diffuse erythematous villous synovitis with a tortuous vascular morphology. None of the 35 patients with early untreated arthritis exhibited all the characteristic features of BD synovitis. This exploratory study shows some distinctive features between BD and PsA knee synovitis that confirm macroscopic differences in patients with previously reported immunopathological differences.