Bone turnover markers in clinical practice and their potential use in HIV-related bone disease

Bone metabolism is characterized by two opposing activities coupled in time and space in the so-called ‘bone remodelling units’. Through a continuous remodelling cycle old bone is resorbed by osteoclasts while osteoblasts deposit new bone. Bone loss is due to an imbalance between bone resorption and formation. Biochemical markers provide a dynamic view of the remodelling process, which can improve fracture risk prediction. Furthermore, they can be used to monitor the short-term effects of therapy, treatment efficacy and patient compliance. Markers of bone remodelling can be dosed in plasma and/or urine, as indicators of osteoblast function or osteoclast function. The significance of any bone turnover marker (BTM) depends on two fundamental characteristics: specificity and variability. The biological variability may determine some limitations in the interpretation of the data. Even though some uncertainties on how to interpret a given result are not resolved as yet, it is impossible to ignore the utility of BTM. As they are easy to obtain and inexpensive compared with other not always mandatory examinations, it seems justified to use BTM in our clinical practice.
HIV-related bone disease is characterized by a high turnover state, with an exaggerated osteoclastic bone resorption and delayed osteoblastic bone formation. Few data exist on the relevance of BTM in HIV-infected patient management. Following the considerations drawn for the general population we suggest that, at least in osteoporotic HIV-patients, BTM be used both to increase the ability of fracture prediction and to monitor the response to anti-resorptive therapy.
Keywords: Osteoporosis; HIV; Bone turnover markers.

Articolo presente in – HAART and correlated pathologies n. 2

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Diagnostic assessment of primary and HIV-induced osteoporosis


Osteoporosis is a common, often disregarded, disease entailing an increased risk of bone fractures. Bone turnover is the main bone quality parameter, currently measured by biochemical markers, possibly flanked by traditional x-ray investigation. A series of observations on increasingly large cohorts of HIV patients have placed HIV infection among the causes of secondary osteoporosis. It is evident that high bone turnover, as in HIV-induced osteoporosis, involves cancellous bone earlier and to a greater extent, only compromising cortical bone much later. For this reason, BMD measurement in the spine is more likely to disclose osteoporotic disease than tests undertaken in femur. Much progress has been made since the first reports of HIV and HAART-induced bone damage, but we have yet to reach an adequate diagnostic definition.
Key words: HIV, Diagnostic of osteoporosis, Primary osteoporosis, HIV-1 related osteoporosis

Articolo presente in – HAART and correlated pathologies n. 0

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