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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.

Reading time approx. 5 minutes Published: September 18, 2019 Publication type:

SBU Enquiry Service

Consists of structured literature searches to highlight studies that can address questions received by the SBU Enquiry Service from Swedish healthcare or social service providers. We assess the risk of bias in systematic reviews and when needed also quality and transferability of results in health economic studies. Relevant references are compiled by an SBU staff member, in consultation with an external expert when needed.

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Published: September 18, 2019 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

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.
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.
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.
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.

Page published September 18, 2019

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