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. 2021 Jun 28;21(1):744.
doi: 10.1186/s12885-021-08518-9.

Effect of cachexia on bone turnover in cancer patients: a case-control study

Hannes Zwickl  1 , Elisabeth Zwickl-Traxler  1   2 , Alexander Haushofer  3 , Josef Seier  3 , Klaus Podar  1   2 , Michael Weber  1 , Klaus Hackner  1   4 , Nico Jacobi  5 , Martin Pecherstorfer  1   2 , Sonia Vallet  6   7
Affiliations

Effect of cachexia on bone turnover in cancer patients: a case-control study

Hannes Zwickl et al. BMC Cancer. .

Abstract

Background: Increased bone turnover is frequently observed in advanced cancer and predominantly related to bone metastases or therapy. Cachexia represents an important cause of morbidity and mortality in cancer patients. Key features are weight loss, muscle wasting and chronic inflammation, which induce profound metabolic changes in several organs, including the bone. However, whether cachexia contributes to abnormal bone metabolism in cancer patients is unknown. Aim of the present study was to determine the potential correlation of bone turnover markers with body composition and laboratory parameters in treatment-naïve cancer patients.

Methods: In this cross-sectional study we measured the levels of carboxy terminal telopeptide of collagen (CTX), an indicator of bone resorption, as well as osteocalcin (Ocn) and procollagen type I N-terminal propeptide (PINP), indicators of bone formation, in 52 cancer patients and correlated with body composition and laboratory parameters. Univariate and multivariate logistic analysis were performed to identify determinants of negative bone remodeling balance, estimated by CTX/Ocn and CTX/PINP ratio.

Results: Based on weight loss, body mass index and muscle mass, patients were divided into a cachectic (59.6%) and a control (40.4%) group. After correcting for the presence of bone metastases, our results showed a significant upregulation of CTX in cachectic patients compared to non-cachectic cancer patients (median 0.38 vs 0.27 ng/mL, p < 0.05), with no difference in Ocn and PINP levels (mean 14 vs. 16 ng/ml, p = 0.2 and median 32 vs. 26 μg/L, p = 0.5, respectively). In addition, the CTX/Ocn and the CTX/PINP ratio were indicative of bone resorption in 68% and 60% of cachexia patients, respectively (vs. 20% and 31% in the control group, p = 0.002 and p = 0.06). The main determinants of the unbalanced bone turnover were hypoalbuminemia for the CTX/Ocn ratio (OR 19.8, p < 0.01) and high CRP for the CTX/PINP ratio (OR 5.3, p < 0.01) in the multivariate regression analysis.

Conclusions: CTX is substantially higher in cachectic patients compared to non-cachectic oncological patients and hypoalbuminemia as well as elevated CRP concentrations are independent predictors of a negative bone remodeling balance in cancer patients. These results strongly indicate that cachexia correlates with exacerbated bone turnover in cancer.

Keywords: Bone turnover; CRP; Cachexia; Carboxy terminal telopeptide of collagen type I (CTX); Hypoalbuminemia; Osteocalcin (Ocn); Procollagen type I N-terminal propeptide (PINP).

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Conflict of interest statement

KP has received speaker’s honoraria from Celgene, Amgen Inc. and Janssen Pharmaceuticals, consultancy fees from Celgene, Takeda, Janssen Pharmaceuticals and Amgen, and research support from Roche Pharmaceuticals.

SV has received speaker’s honoraria from Bristol Myers Squibb, Pfizer, MSD, Merck; consultancy fees from Roche, MSD, EUSA Pharma, Merck and travel support from Pfizer, Roche, Pierre Fabre, Angelini.

The other authors declare that there are no conflicts of interest.

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