Bone resorption predicts for skeletal complications in metastatic bone disease

Br J Cancer. 2003 Dec 1;89(11):2031-7. doi: 10.1038/sj.bjc.6601437.


Relationships between the rate of bone resorption (measured by urinary N-telopeptide (Ntx) excretion) and a range of skeletal complications have been evaluated in patients with metastatic bone disease. A total of 121 patients had monthly measurements of Ntx during treatment with bisphosphonates. All skeletal-related events, plus hospital admissions for bone pain and death during the period of observation, were recorded. Data were available for 121 patients over the first 3-month period of monitoring (0-3 months) and 95 patients over the second 3-month period (4-6 months). N-telopeptide levels were correlated with the number of skeletal-related events and/or death (r=0.62, P<0.001 for 0-3 months and r=0.46, P<0.001 for 4-6 months, respectively). Patients with baseline Ntx values > or =100 nmol mmol(-1) creatinine (representing clearly accelerated bone resorption) were 19.48 times (95% CI 7.55, 50.22) more likely to experience a skeletal-related event/death during the first 3 months than those with Ntx <100 (P<0.001). In a multivariate logistic regression model, Ntx was highly predictive for events/death. This study is the first to indicate a strong correlation between the rate of bone resorption and the frequency of skeletal complications in metastatic bone disease. N-telopeptide appears useful in the prediction of patients most likely to experience skeletal complications and thus benefit from bisphosphonate treatment.

Publication types

  • Evaluation Study

MeSH terms

  • Aged
  • Biomarkers
  • Bone Diseases / complications*
  • Bone Diseases / diagnosis*
  • Bone Neoplasms / complications*
  • Bone Neoplasms / secondary*
  • Bone Neoplasms / urine
  • Bone Resorption*
  • Collagen / urine*
  • Collagen Type I
  • Creatinine / urine
  • Female
  • Humans
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Odds Ratio
  • Peptides / urine*
  • Time Factors


  • Biomarkers
  • Collagen Type I
  • Peptides
  • collagen type I trimeric cross-linked peptide
  • Collagen
  • Creatinine