Diagnostic and prognostic value of biochemical markers in malignant bone disease: A prospective study on the effect of bisphosphonate on pain intensity and progression of malignant bone disease

Seventy cancer patients with malignant osteolytic bone disease received pam idronate every three weeks for a maximum of six cycles. Bone resorption par ameters, urinary calcium excretion, and pain parameters were assessed at ba seline and throughout the study. At baseline, 80-95 % of patients showed el evated urinary pyridinoline, deoxypyridinoline, Osteomark(R) NTx and serum ICTP(R) levels, whereas only 35 % of patients had elevated urinary CrossLap s(R) excretion rates. During bisphosphonate therapy, significant decreases in Osteomark(R) NTx, CrossLaps(R) and calcium excretion were observed, whic h were not related to the clinical outcome. The baseline levels of bone res orption markers were used to predict the probability of non-progressive bon e disease or reduction in pain intensity during bisphosphonate therapy. Sig nificant predictors of non-progressive bone disease were urinary pyridinoli ne and serum ICTP levels; significant predictors of reduction in pain inten sity were urinary free deoxypyridinoline and serum ICTP levels. Our data indicate that serum ICTP levels predict significantly the response to bisphosphonate therapy in patients with advanced malignant osteolytic b one disease. CrossLaps did not predict the clinical outcome, but decreased significantly during bisphosphonate therapy. Our data demonstrate that the different bone resorption markers are reflecting different aspects of bone metabolism, and therefore differ in their diagnostic and prognostic propert ies.