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Department of Hematology & Medical Research
251 General Airforce Hospital
By Lynne Lederman, PhD
In addition to urinary NTX, serum CTX, and serum C-terminal cross-linking telopeptide of type-I collagen (the main collagen in bone) generated by metalloproteinases (ICTP) may be measured to monitor bone lesions in patients with myeloma. Levels increase prior to skeletal events in patients with progressive disease, and high levels are correlated with a higher risk of and shorter time to skeletal events. Baseline levels of NTX are an independent prognostic indicator of death but BALP is not a prognostic indicator. The serum RANKL/OPG ratio correlates with markers of bone resorption, and tartrate-resistant acid phosphatase type-5b (TRACP-5b), which is produced by activated osteoclasts is associated with severity of bone lytic disease. Response to treatment with thalidomide was associated with reduced NTX and CTX levels. Treatment with bortezomib reduces CTX and TRACP. More work is needed to determine the role of these markers in assessment of response to treatment. Dr. Terpos reported that the experience with ONJ in Greek studies reflected that reported by Dr. Berenson. Most studies have been retrospective, the mechanism of induction of ONJ, other risk factors, prevention, and treatment need to be determined. A prospective, randomized trial of zolendronic acid given on two different schedules may answer some of these questions.