Context: Osteoporosis is a terrible disease that causes bone loss and weakens bone tissue's structural integrity. Fractures caused by osteoporosis can occur in any area of the bone, although they are most common in the forearm, thoracic, and lumbar vertebrae, as well as the proximal femur. Hip fractures have a significant mortality and morbidity rate among them. Fragility hip fractures as a result of osteoporosis are becoming more common. There is a lot of current study in the field of orthopaedics because traditional radiography can't reliably detect bone loss, thus a non-invasive examination into measuring the bone mineral content of various sections of the skeleton has been developed. Because the existing ‘gold standard' DEXA test has substantial shortcomings, extensive research will be conducted to develop a better study to replace DEXA. Any new technology must be repeatable and capable of assisting in the evaluation of both quantity and quality, as well as being a good assessor of someone's fracture risk. N- Telopeptide (NTx) has been studied as a bone resorption measure that is both selective and sensitive. NTx is a stable degradation end product that may be detected in both serum and urine. Diet has little effect on urine excretion, hence there is less variance than with traditional markers. Because of the unique amino acid sequence and orientation of cross-linked alpha-2 [1] N Telopeptide, the NTx is particular to bone. The osteoclast is responsible for the production of the NTx molecule.
The goal of this study was to see if urine n telopeptide might be used as a diagnostic test for osteoporosis. The study's goal is to see if urinary n telopeptide levels can be used as a diagnostic tool for osteoporosis. The purpose of this study is to evaluate the utility of urine n telopeptide and to investigate its relationship with BMD. To determine the best cut-off point for osteoporosis classification using urinary n telopeptide levels.
Materials and Methods: This is a prospective study conducted at Chennai's Sri Ramachandra Institute Of Higher Education and Research (DU). The research took place between August 2014 and December 2019. Before collecting the samples, the SRIHER (DU) ethics committee gave its approval. Females aged 65 and above, females aged 60 and up with risk factors, postmenopausal young females with one or more risk factors, males aged 70 and up, males aged less than 50 with risk factors, and patients seen within 24 hours of minor fall fractures were all included. Patients with a BMI of less than twenty, Asian ethnicity, and a sedentary lifestyle were all risk factors. Family history of osteoporosis or fragility fractures, a sustained previous fracture or a recent fragility fracture, prolonged steroid use, more than two to three alcoholic drinks per day, early menopause before the age of forty-five years, vitamin D deficiency, testosterone hormone depletion in males, and neurological illness such as dementia that makes a person prone to fall. People with any pathological fracture, chronic or acute kidney illness, liver failure, tumour and malignancy, hyperthyroidism or hyperparathyroidism, and any medicines that alter bone metabolism were all excluded. Patients with probable osteoporosis who came to Sri Ramachandra Hospital as inpatients or outpatients were studied. All patients were given a thorough explanation of the study, and after receiving their agreement, they were enrolled in it. DEXA scan, urinary N-telopeptide, and biochemical tests such as blood calcium, serum phosphorus, alkaline phosphatase, 25-hydroxy vitamin D, and serum parathyroid were performed on all study participants. Patients were separated into cases and controls based on the results of a DEXA scan. After consultation with a statistician, the sample size for each group was determined to be 43.
The mean urine N telopeptide value was 182.5 in cases and 49.9 in controls, which is statistically significant. The receiver operating curve was created using the X axis for 1-specificity and the Y axis for sensitivity. According to the ROC curve, the cutoff was found to be 71. The sensitivity and specificity of the urine N telopeptide test were determined using a cutoff of 71 and found to be 85 percent sensitivity and 86 percent specificity.
Discussion: DEXA delivers a static image of the bones and does not discriminate whether or not bone loss is occurring. However, urine N -telopeptide is a dynamic indicator of what is going on in the bone at any one time. In the current investigation, the mean levels of urine N-telopeptide in the patients and controls were 182.5 and 49.8, respectively. Significant associations between bone turnover indicators and BMD at the lumbar spine and total hip of postmenopausal women were discovered on a regular basis. Discussion: DEXA delivers a static image of the bones and does not discriminate whether or not bone loss is occurring. However, urine N -telopeptide is a dynamic indicator of what is going on in the bone at any one time. In the current investigation, the mean levels of urine N-telopeptide in the patients and controls were 182.5 and 49.8, respectively. Significant associations between bone turnover indicators and BMD at the lumbar spine and total hip of postmenopausal women were discovered on a regular basis. In the postmenopausal age group, the typical reference value of urine N- telopeptide was up to 89 nmol bone collagen equivalents/nmol creatinine. The reference value was derived from the European population, but no reference figure for the Indian population was provided. If the cutoff is set at 89 and the sensitivity is determined, the result is 71, with an increase in false negatives. Thus, a new cut-off for the Indian population is required, and the study's cut-off of 71 for urinary N-telopeptide has good sensitivity, specificity, and accuracy. According to the findings of this study, 71 could be used as a cut-off point for diagnosing osteoporosis in order to distinguish between normal and osteopenic/osteoporotic patients. Any number greater than 71 indicates osteoporosis/osteopenia, whereas very elevated levels (>1.5-2) may suggest the presence of other bone diseases such as osteomalacia. DEXA is more expensive than assessing urinary N- telopeptides. A single area DEXA scan costs approximately 2500 rupees, while an urine N- telopeptide Elisa kit costs approximately 25000 rupees for 100 patients. If the urinary N-telopeptide test is performed more regularly and in greater numbers, the kit can be acquired at a lower cost. When we use a DEXA scan alone to diagnose osteoporosis, we may encounter several issues. Only bone resorption is directly proportional to the value of urinary N- telopeptide. Increased levels of bone resorption markers indicate a higher risk of fracture regardless of bone mineral density. The combination of the two diagnostic tests could help women at high risk be better identified.
Conclusion: Elevated urine N- telopeptide can be used to detect osteoporosis/osteopenia and could be used as a new osteoporosis diagnostic test. The test can also be used as a screening test because it is inexpensive, non-invasive, and straightforward. According to the current study's receiver operating characteristic curve, the cutoff for osteopenia/osteoporosis and normal categorization is 71. Vitamin D levels, PTH levels, and phosphorus levels show no link to osteoporosis. For suspected osteoporosis, a urine N-telopeptide test is recommended, with individuals who test positive (i.e. more than 71) being referred to the current ‘gold standard' DEXA scan. A combination of these two diagnostic tests could be utilised to identify those who are at high risk of fracture. Urinary N telopeptide has the potential to be utilised as both a screening and diagnostic test.
Author(s) Details
Ganesan G. Ram
Professor of Orthopaedics, Velammal Medical College, Madurai, Tamil Nadu, India.
View Book:- https://stm.bookpi.org/OUNT/article/view/2330
No comments:
Post a Comment