The Correlation between Total Alkaline Phosphatase and Osteocalcin Levels in Systemic Lupus Erythematosus Patients
DOI:
https://doi.org/10.24293/ijcpml.v28i3.1668Keywords:
Systemic lupus erithematosus, osteoporosis, total alkaline phosphatase, osteocalcinAbstract
Systemic Lupus Erythematosus (SLE) is a chronic autoimmune inflammatory disease with various complications, including osteoporosis. However, Bone Mineral Density (BMD) examination, a gold standard for diagnosing and monitoring osteoporosis, is static. Alkaline phosphatase (ALP) is a membrane-bound glycoprotein that catalysis the hydrolysis of monoester phosphate. Osteocalcin (OC) is a non-collagenic bone protein that binds calcium and phosphate, which are both dynamic bone formation activity markers. This study analyzes the correlation between total ALP and OC serum levels in SLE patients. A cross-sectional observational analytic study was conducted in the Clinical Pathology Installation of Dr. Moewardi Hospital Surakarta in June 2020. The subjects were SLE patients receiving Methylprednisolone (MEP) therapy ≥1 year. Data distribution normality test by Saphiro-Wilk, comparative analysis with unpaired T-test, degree of correlation strength between research variables by Pearson correlation test. There were 41 female subjects, and comparative analysis of total ALP and serum OC levels were not significantly different in inactive and active SLE (ALP p=0.373, serum OC p=0.700). Total ALP and serum OC was found to have a weak positive correlation in all SLE patients (r=0.337; p=0.031), a moderate positive correlation in active SLE (r=0.426; p=0.043), while in inactive SLE there was no significant correlation (r=0.247; p=0.324). There is a significant moderate positive correlation between total ALP and serum OC in SLE patients. Total ALP and serum OC examinations are necessary for osteoporosis screening in SLE patients with > 1-year glucocorticoid (GC) therapy.Downloads
References
Atmakusuma TD, Lydia A, Gunawan A, Yunihastuti E, Widhani A, et al. Rekomendasi Perhimpunan
Reumatologi Indonesia untuk diagnosis dan pengelolaan lupus eritematosus sistemik. PRI, 2019; 5-35.
Ali A, Sayyed Z, Ameer MA, Arif AW, Kiran F, et al. Systemic lupus erythematosus: an overview of the
disease pathology and its management. Cureus, 2018; 10(9): e3288.
Sutrisno RN, Rahmadi AR, Novita N, Hamijoyo L. Most frequent musculoskeletal manifestation of systemic lupus erythematosus patients in Dr. Hasan Sadikin General Hospital Bandung. Ind. J. of Rheum, 2017; 9(2): 13-17.
Elhefny AAM, Hamza SMH, ElSherbiny DAH, Ibraheem RF. Frequency of low bone mineral density and
Osteoporosis in a cohort of Egyptian patients with systemic lupus erythematosus. EJHM, 2017; 69(3):
-2035.
Kuo TR, Chen CH. Bone biomarker for the clinical assessment of osteoporosis: recent developments and future perspectives. Biomarker Research, 2017; 5(18): 1-9.
Singh S, Kumar D, Lal AK. Serum osteocalcin as a diagnostic biomarker for primary osteoporosis in
women. JCDR, 2015; 9(8): RC04-RC07.
Fraser WD. Bone and mineral metabolism. In: Tietz fundamentals of clinical chemistry and molecular
diagnostics. 7th Ed., Missouri, Elsevier, 2019; 744-771.
Proline. Proline R-90 alkaline phosphatase FS IFCC mod. 370C. Prodia Diagnostic Line, Cikarang, 2017; 1-2.
Roche. Elecsys N-MID Osteocalcin kit. Roche Diagnostics GmbH, Mannheim, 2019; 1-4.
Castillo JM, Sánchez MAR, Márquez AMB. Prolactin as a marker of active disease in systemic lupus
erythematosus. International Journal of Biomedical Engineering and Clinical Science, 2021; 7(4): 73-76.
Dewi YP. An overview: Vitamin D. 2019. Available from: https://www.researchgate.net/publication/319997190 (accessed April 5, 2020).
Madiyono B, Sastroasmoro S, Budiman I, Purwanto SH. Perkiraan besar sampel dalam dasar-dasar
th metodologi penelitian klinis. 5 Ed., Jakarta, Sagung Seto, 2018; 352-386.
Dahlan MS. Statistik untuk kedokteran dan kesehatan. th 6 Ed., Jakarta, Epidemiologi Indonesia, 2017; 223-244.
Franco JCP, Henao MPZ, Pineda FL, Pulgarin-Montoya S, Vallejo EO, et al. Low bone mass and osteoporosis in patients with systemic lupus erythematosus. Rev. Colomb Reumatol, 2017; 24(1): 4–10.
Xia J, Luo R, Guo S, Yang Y, Ge S, Xu G, Zeng R. Prevalence and risk factors of reduced bone mineral
density in systemic lupus erythematosus patients: A meta-analysis. BioMed Research International, 2019; 1-10.
Nusbaum JS, Mirza I, Shum J, Freilich RW, Cohen RE, et al. Sex differences in systemic lupus erythematosus: epidemiology, clinical considerations, and disease pathogenesis. Mayo Clinic Proc, 2019; 95(2): 384-394.
Nashirin AK, Zaki A, Nurmilasari, Widjajakusumah D, Fadhilah M. Hubungan nilai indeks massa tubuh dengan nilai risiko fraktur osteoporosis berdasarkan perhitungan Frax tool pada wanita usia ≥ 50 tahun di klub bina lansia Pisangan Ciputat Tahun 2015. JMI, 2015; 12(2); 188-194.
Stojan G, Petri M. The risk-benefit ratio of glucocorticoids in SLE: Have things changed over the
past 40 years?. Curr Treatm Opt Rheumatol, 2017; 3(3): 164-172.
Briot K, Roux C. Glucocorticoid-induced osteoporosis. RMD Open, 2015; 1(e000014): 1-8.
Kenkre JS, Bassett JHD. The bone remodelling cycle. An. Clin. Biochem, 2018; 1-20.
Dima A, Opris D, Jurcut C, Baicus C. Is there still a place for erythrocyte sedimentation rate and C-reactive protein in systemic lupus erythematosus?. Lupus, 2016; 1-7.
Watad A, Tiosano S, Azrielant S, Whitby A. Low levels of calcium or vitamin D, which is more important in systemic lupus erythematosus patients? An extensive data analys i s . Clinical and Experimental Rheumatology, 2016; 1-5.
Suzan R. Korelasi antara asupan vitamin D dengan kadar 25(Oh)D serum pada pasien lupus eritematosus sistemik perempuan dewasa. JMJ, 2018; 6(1): 56-67.
Hafez EA, El Bakry SA, Ibrahim SI, Morad CS, Hamza SA, El Khaliq DMA. Assessment of fracture risk in a cohort of Egyptian female systemic lupus erythematosus patients. The Egyptian Rheumatologist, 2018; 40: 85-91.
Adami G, Fassio A, Rossini M, Caimmi C, Giallo A, et al. Osteoporosis and rheumatic disease. Int. J. Mol. Sci, 2019; 20(5867): 1-23.
Sarkissian A, Sivaraman V, Bout-Tabaku S, Ardoin SP, Moore-Clingenpeel M, et al. Bone turnover markers in relation to vitamin D status and disease activity in adults with systemic lupus erythematosus. Lupus, 2018; 1-7.
Zoch ML, Clemens TL, Riddle RC. New insights into the biology of osteocalcin. Bone, 2016; 82: 42–49.
Klemm KM, Klein MJ. Biochemical markers of bone metabolism. In: Henry's clinical diagnosis and
management by laboratory methods. 23 Ed., Missouri, Elsevier, 2017; 188-204
Submitted
Accepted
Published
How to Cite
Issue
Section
License
Copyright (c) 2022 INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
