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The clinical utility of TRACP-5b to monitor anti-resorptive treatments of osteoporosis

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Abstract

Summary

TRACP-5b can be used to monitor the response of treatments in osteoporosis. We investigated the effect of feeding on levels of TRACP-5b and how these markers perform in a clinical setting. After feeding, there was no effect on levels TRACP-5b. It has similar diagnostic accuracy to CTX and PINP.

Introduction

Bone turnover markers (BTMs) can be used to monitor response to osteoporosis treatment. However, some are affected by food intake and are not suitable to measure in a clinical setting. An assay is available which is capable of detecting the active isoform 5b of tartrate resistance acid phosphatase (TRACP-5b) and it may have minimal biological variation. Our aims were to investigate the effect of feeding on levels of TRACP-5b and compare this to CTX and PINP and then to compare the diagnostic accuracy of TRACP-5b to CTX and PINP in patients with osteoporosis given commonly used treatments.

Methods

Eighteen patients were recruited to investigate the effect of feeding on BTMs. Ninety-seven patients (74 females and 23 males) receiving 5 mg annual intra-venous zoledronate (mean age 70) and 97 patients receiving no treatment were recruited as group-matched controls. Sixteen patients receiving 60 mg subcutaneous denosumab every 6 months, (mean age 76) and 16 matched controls were recruited. Seventy-six patients were receiving oral bisphosphonates: 70 mg alendronate weekly, 35 mg risedronate and 150 mg monthly ibandronate (4%). Thirty of these patients had BMD measured at the total hip and lumbar spine. An estimate of compliance was not determined. Eighty patients receiving no treatment were recruited as group-matched controls. TRACP-5b (ELISA, Nittobo) and CTX and PINP were measured in serum in the non-fasting state between 0800 and 1700.

Results

After feeding, there was no effect on levels TRACP-5b and significant reductions in CTX and PINP, 29% and 10%, respectively (p < 0.001). In the zoledronate and denosumab groups, there were no differences in the areas under the curves (AUCs) between TRACP-5b, PINP and CTX. In the oral bisphosphonates group, the AUCs between TRACP-5b and PINP and TRACP-5b and CTX were significantly different, p < 0.01 and p = 0.001, respectively. TRACP-5b was negatively correlated with BMD.

Conclusion

TRACP-5b is not affected by food intake, unlike CTX and PINP. All three BTMs correlate with change in BMD at the lumbar spine and total hip. TRACP-5b has similar diagnostic accuracy to CTX and PINP with commonly used treatments for osteoporosis with the exception of oral bisphosphonate therapy.

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Authors and Affiliations

  1. Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK

    F. Gossiel, A. Ugur, J. S. Walsh & R. Eastell

  2. The Medical School, Beech Hill Road, Sheffield, S10 2RX, UK

    F. Gossiel

  3. Sheffield Teaching Hospitals NHS Trust, Sheffield, UK

    N. F. A. Peel

Authors
  1. F. Gossiel
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  2. A. Ugur
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  3. N. F. A. Peel
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  4. J. S. Walsh
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  5. R. Eastell
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Corresponding author

Correspondence to F. Gossiel.

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Conflict of interest

R Eastell receives consultancy funding from IDS, Sandoz, Nittobo, Samsung, Haoma Medica, CL Bio, Biocon, Amgen, Hindustan Unilever, Pharmacosmos, Takeda and Viking and grant funding from Nittobo, Roche, Pharmacosmos and Alexion. J Walsh has received speaker’s honoraria from Lilly and the donation of drug and placebo from Prostrakan. N Peel has received speaker’s honoraria and funding to attend educational events from Warner-Chilcott, Lilly, Amgen, GSK and Prostrakan and consultancy fees from Internis Pharma and Lilly. F Gossiel and A Ugar declare that they have no conflict of interest.

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Gossiel, F., Ugur, A., Peel, N.F.A. et al. The clinical utility of TRACP-5b to monitor anti-resorptive treatments of osteoporosis. Osteoporos Int 33, 1357–1363 (2022). https://doi.org/10.1007/s00198-022-06311-3

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  • DOI: https://doi.org/10.1007/s00198-022-06311-3

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