SULM – Schweizerische Union für Labormedizin | Union Suisse de Médecine de Laboratoire | Swiss Union of Laboratory Medicine

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Nadia Barghash, Nahla Hamed, Yousri Rostom, Hesham El-Saygh, Ehsan Abd Al-Rahman

1Medical Biochemistry Dept. Faculty Of Medicine,Alexandria University Egypt ity , 2Internal Medicine Dept. Faculty of Medicine ,Alexandria University Egypt, 3Clinical Oncology & Nuclear Medicine Dept.Faculty of Medicine,Aexandria University Egypt Alexandria University, 4Internal Medicine Dept. Faculty Of Medicine, Alexandria University Egypt, 5Medical Biochemistry Dept. Faculty of Medicine, Alexandria University Egypt

Osteoprotegerin (OPG) and its ligand ' RANKL' (receptor activator of NF-kB ligand) are novel regulators of osteoclast formation. Furthermore, OPG appears to be a novel therapeutic agent for treating disorders of bone resorption. So, we aimed at investigating their diagnostic significance in female patients of comparable age suffering from diseases characterized by excessive bone resorption: 10 patients with stage II multiple myeloma, 15 patients with breast cancer metastasizing to the bone (TNM stage IV) and 10 patients with renal osteodystrophy on hemodialysis. Also, we try to find their relationship with changes in glycosaminoglycan (GAG) and collagenase. Ten healthy women of matched age served as controls. Use of any medication affecting bone and calcium metabolism by patients or controls, women who were on hormone replacement therapy or presence of chronic diseases in cancer patients were indications for their exclusion. Results showed statistically significant elevation of serum RANKL, collagenase and GAG in multiple myeloma and breast cancer groups as compared to controls and renal osteodystrophy while OPG was significantly lower than controls in multiple myeloma only. This is explained by the presence of combined bone and liver metastasis in some breast cancer patients. In both groups, collagenase and GAG were inversely correlated with OPG and directly correlated with RANKL. In renal osteodystrophy, OPG was statistically higher than all groups and directly correlated with collagenase and GAG. Based on these results, we concluded that OPG and RANKL had a diagnostic value in multiple myeloma and in breast cancer metastasizing to the bone. However, the diagnostic value of OPG in certain situations such as renal osteodystrophy and presence of combined bone and liver metastasis needs further assessment. The mechanism and role of elevated OPG in these conditions might partly represent a compensatory mechanism to negative balance of bone remodeling or impaired clearance.


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