Bone alkaline phosphatase, osteocalcin and lumbar-spine bone mineral density in pre- and postmenopausal women who developed bone metastases from advanced cancer

BMD measurement is a widely accepted quantitative method for diagnosing osteoporosis and predicting fracture risk, while bone alkaline phosphatase (BAP) and osteocalcin assay are of value in estimating bone turnover rates, both in pre- and in postmenopausal women. Low bone mass and bone metastases (BMs) mostly coexist in patients with BMs, but it is unclear the relationship between markers of bone turnover and bone density. The aim of this study was to investigate the relationship between lumbar spine (LS)-BMD, BAP and osteocalcin serum levels in pre-and postmenopausal women who developed BMs from advanced NSCLC and BC. Patients & Methods: 26 women (median age 50 years, range 34–74) with advanced cancer and BMs were enrolled in the study. There were 14 premenopausal (Group A) and 12 postmenopausal (Group B) patients, who underwent both DXA and LS-BMD measurement, and serum ALP and osteocalcin assay. Results: In postmenopausal women, both serum osteocalcin (34.2±12.8 vs. 28.0±6.7 U/L, p=0.13) and BAP (29.6±9.1 vs. 29.4±12.0, p=0.99) levels were increased as compared to premenopausal women. As expected, in both groups (Avs. B), there was a strong inverse relationship between age and osteocalcin (R=0.61, p=0.02 vs. R=0.92, p=0.00002) or LS-BMD (R=0.52, p=0.056 vs. R=0.89, p=0.0001), but no correlation between BAP and age (R=0.23, p=0.42 vs. R=0.16, p=0.61) or LS-BMD (R=0.15, p=0.61 vs. R=0.12, p=0.71). However, osteocalcin inversely correlated to BMD only among postmenopausal patients (R=0.73, p=0.007 vs. R=0.35, p=0.22). Conclusion: Our results suggest that osteocalcin and BAP are not useful in the early diagnosis of BMs in women with advanced cancer, because there is a significant correlation between these markers and LS- BMD only in postmenopausal women, which can be justified by the fact that bone density in this group are physiologically lower.