Resolved question:
Hello,
You told me one time, not to worry that my urinary N-telopeptide and C-telopeptide tests were elevated, because they are unreliable. (all my blood bone turnover tests were normal). I have very dense bones, for osteoporosis is not an option.
I still worry because they indicate high bone turnover, and possible mets. Also, my urine calcium test was VERY SLIGHTLY elevated. Seems that everything with my urine test was wrong, and everything with my blood tests were o.k.
Why are the urinary telopeptide tests so unreliable? What normal things can affect them, to make them high when they shouldn't be? I know you say chemo can't do it. But, could being put into premature menopause cause it?
I'm just trying to understand why they are unreliable, and maybe that will make me feel less worried.
Submitted:
4 Days
Category:
Oncologist
Hello,
Thank you for your consult.
Urinary telopeptides are one of the few excretory end products of bone formation and remodelling. Not necessarily indicating osteoporosis. It can be elevated even in dense bones, as this is also a type of remodelled bone formation.
In Bone metastasis, there is an ongoing bone formation and destruction by the bone forming and bone destroying cells. This just indicates ongoing bone remodelling.
When bone scans are negative, these finding ( elevated telopeptides ) need not be seen as
Markers of bone metastasis.
Please be assured that it is still not adopted as standard practice recommendation to change clinical decisions based on markers.
Regards.
Thank you.
So, do you consider these markers generally unreliable? I think I told you before that I read on wikipedia that they can change for seemingly no reason.
Do you have any idea what can make them change for reasons other than mets or bone remodelling (for example inflammation? something else?).
A detailed answer with a simple description is available in the following links. Please go through these.
http://www.aacc.org/publications/cln/2013/july/Pages/Bone-Turnover-Markers.aspx
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1320175/
http://www.ccjm.org/content/75/10/739.full
Thank you for the articles. I have been looking at them, but I think they are a bit too technical for me.
What I really want to know, is if these telopeptide markers can be raised as high as mine are, and still not be cancer? And I also wish you could give me a reason why they would go so high?
You have dense bones which show ongoing bone remodeling since quite a few years. This may be the reson for your elevated telopeptide markers.
Since your bone scan was negative I would not consider cancer as a cause. In the present situation I would recommend you to be on a regular followup for the prevalence.
Regards.
Did you once tell me that it would take many many years old patientfor ALLRED 8 cancer to mutate so AI's would not be effective anymore?
Thanks!
Hello.
No. I said high ALLRED score tumor grow slowly and mutation takes years old patientto make cells resistant to AI. Till that time, AI will be effective. Even if it fails, there are multiple other lines of hormones which have a different mechanism of action.
Regards.