Relationship between S-CTX or PINP levels and decreased bone density

S-CTX (Serum C-telopeptide cross-link type 1 collagen) is a biochemical marker for bone resorption and PINP (Procollagen Type 1 N-terminal propeptide) is a biomarker for bone formation. Patients with osteoporosis often medicate with bisphosphonates, but when a patient stops treatment follow-up is important to see if the medication needs to be resumed.

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Responds to queries received from Swedish healthcare and social service providers, or governmental organisations. Queries have a limited scope and the process is designed to enable a more rapid response, typically within two to three months. Reports are based on systematic reviews, that are identified through structured searches and critically appraised for risk of bias.

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Published: Report no: ut201921 Registration no: SBU 2018/595

Question

What scientific studies are there on the relationship between S-CTX or PINP levels and decreased bone density or increased fracture risk in postmenopausal women previously treated with bisphosphonate?

Identified studies

One systematic review with high risk of bias and 3 primary studies were found. The primary studies were not assessed for risk of bias.

References

  1. Funck-Brentano, T, Biver, E, Chopin, F, Bouvard, B, Coiffier, G, Souberbielle, JC, et al. Clinical utility of serum bone turnover markers in postmenopausal osteoporosis therapy monitoring: a systematic review. Seminars in arthritis and rheumatism. 2011; 41(2):157-69.
  2. Bagger, YZ, Tanko, LB, Alexandersen, P, Ravn, P, Christiansen, C. Alendronate has a residual effect on bone mass in postmenopausal Danish women up to 7 years after treatment withdrawal. Bone. 2003; 33(3):301-7.
  3. Kim, T, Bauer, D, Schafer, A, Cosman, F, Black, D, Eastell, R. Comparison of BMD changes and bone turnover levels 3 years after bisphosphonate discontinuation: FLEX and HORIZON Studies. Journal of Bone and Mineral Research. 2017; 32:S26.
  4. Naylor, KE, McCloskey, EV, Jacques, RM, Peel, NFA, Paggiosi, MA, Gossiel, F, et al. Clinical utility of bone turnover markers in monitoring the withdrawal of treatment with oral bisphosphonates in postmenopausal osteoporosis. Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 2019.

Literature search

PubMed via NLM 2019-03-04

Title: Bone turnover markers after withdrawal of bisphosfonate in osteoporosis

The search result, usually found at the end of the documentation, forms the list of abstracts
  Search terms Items found
Population:
1. post menopause[MeSH Terms] AND osteoporosis[MeSH Terms]  
2. osteoporosis, postmenopausal[MeSH Terms]  
3. osteoporosis[Title/Abstract] AND (post-menopaus*[Title/Abstract] OR post menopaus*[Title/Abstract] OR postmenopaus*[Title/Abstract] OR (post[Title/Abstract] AND menopaus*[Title/Abstract])  
4. 1 OR 2 OR 3  
Intervention:
5. s-pinp[Title/Abstract]) OR pinp[Title/Abstract]) OR "serum pinp"[Title/Abstract]  
Final 4 AND 5 130

 

PubMed via NLM 2019-03-04

Title: Bone turnover markers after withdrawal of bisphosfonate in osteoporosis

The search result, usually found at the end of the documentation, forms the list of abstracts. [MeSH] = Term from the Medline controlled vocabulary, including terms found below this term in the MeSH hierarchy; [MeSH:NoExp] = Does not include terms found below this term in the MeSH hierarchy; [MAJR] = MeSH Major Topic; [TIAB] = Title or abstract; [TI] = Title; [AU] = Author; [TW] = Text Word; Systematic[SB] = Filter for retrieving systematic reviews; * = Truncation
  Search terms Items found
Population:
1. post menopause[MeSH Terms] AND osteoporosis[MeSH Terms]  
2. osteoporosis, postmenopausal[MeSH Terms]  
3. osteoporosis[Title/Abstract] AND (post-menopaus*[Title/Abstract] OR post menopaus*[Title/Abstract] OR postmenopaus*[Title/Abstract] OR (post[Title/Abstract] AND menopaus*[Title/Abstract])  
4. 1 OR 2 OR 3  
Intervention:
5. "ctx"[Title/Abstract] OR "s-ctx"[Title/Abstract] OR sctx[Title/Abstract] OR 
ctx-1[Title/Abstract] OR "serum CTX"[Title/Abstract]		  
Final 4 AND 5 467

 

Cochrane Library via Wiley 2019-03-04

Title: Bone turnover markers after withdrawal of bisphosfonate in osteoporosis

  Search terms Items found
The search result, usually found at the end of the documentation, forms the list of abstracts. au = Author; MeSH = Term from the Medline controlled vocabulary, including terms found below this term in the MeSH hierarchy; this term only = Does not include terms found below this term in the MeSH hierarchy; :ti = Title; :ab = Abstract; :kw = Keyword; * = Truncation; “ “ = Citation Marks; searches for an exact phrase
Population:
1. MeSH descriptor: [Postmenopause] explode all trees 4 450
2. MeSH descriptor: [Osteoporosis] explode all trees 3 722
3. 1 AND 2  
4. MeSH descriptor: [Osteoporosis, Postmenopausal] this term only 1 922
5. osteoporosis:ti,ab,kw 7 622
6. 15 762  
7. 5 AND 6 3 773
8. 3 773  
Intervention:
9. s-pinp OR pinp OR "serum pinp":ti,ab,kw 249
10. "ctx" OR "s-ctx" OR "sctx" OR "ctx-1" OR "serum CTX":ti,ab,kw 1 365
Final 8 AND 9
Cochrane reviews 3
Trials 72
 
#8 AND #10
Cochrane reviews 4
Cochrane protocols 3
Trials 290		 75


 
297
 

Embase via embase.com 2019-03-04

Title: Bone turnover markers after withdrawal of bisphosfonate in osteoporosis

  Search terms Items found
/de = Term from the EMTREE controlled vocabulary; /exp= Includes terms found below this term in the EMTREE hierarchy; /mj = Major Topic; :ab = Abstract; :au = Author; :ti = Article Title; :ti,ab = Title or abstract; * = Truncation; ’ ’ = Citation Marks; searches for an exact phrase
Population:
1. 'postmenopause'/exp AND 'osteoporosis'/exp 11 684
2. 'postmenopause osteoporosis'/exp 13 691
3. 'postmenopausal' OR 'postmenopause' OR 'post-menopausal' OR 'post-menopause' OR 'post menopausal' OR 'post menopause':ti,ab,kw 100 076
4. 'osteoporosis':ti,ab,kw 102 625
5. 3 AND 4 23 639
6. 1 OR 2 OR 5 29 310
Intervention:
7. 'ctx' OR 's-ctx' OR sctx OR 'ctx 1' OR 'serum ctx' 17 657
8. 6 AND 7 1 027
9. 's-pinp' OR 'pinp' OR 'serum pinp' 1 677
10. 6 AND 9 316
11. 'bone turnover' OR 'bone turn over':ti,ab,kw 22 193
12. marker*:ti,ab,kw 985 271
13. 11 AND 12 10 741
Limits: Embase only
14. 9 AND 13 AND [embase]/lim 783
15. 10 AND 13 AND [embase]/lim 211
Final 14 OR 15 AND [embase]/lim 783

Project group

Frida Mowafi, Laura Lintamo, Sara Fundell and Miriam Entesarian Matsson at SBU.

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