LMC journal Vol. 2.indd 59 Original Article L M Coll J 2013; 1(2): 59-61 Evalua on of biochemical marker for bone turnover in post menopausal women Joshi KR, Devi SP and Lanjikar PP Department of Biochemistry, Lumbini Medical College and Teaching Hospital (LMC&TH), Pravas, Palpa, Nepal Corresponding Author: Mr. Keshab Raj Joshi, Lecturer, Dept. of Biochemistry, LMC&TH, Pravas, Palpa, Nepal; e-mail: keshab_ish@yahoo.com / keshabrajoshi@gmail.com ABSTRACT Introduc on: Menopause is the permanent cessa on of menses resul ng from reduced ovarian hormone secre on that occurs naturally or is induced by surgery, chemotherapy, or radia on. Aims and objec ves: To evaluate the risk of accelerated bone loss by assessing bone markers like alkaline phosphatase (ALP) and calcium in postmenopausal women. Material and methods: The present study was carried out on 100 total subjects out of which experimental group consists of 50 subjects i.e Post menopausal women. Control group consists of 50 subjects Pre menopausal women. Results: The result of the present study suggest that the serum calcium level were signifi cantly reduced but the serum alkaline phosphatase (ALP) levels had a slightly raise in post menopause group when compared to the pre menopause groups. Conclusion: In normal post menopausal women, an increase in bone turnover accelerates the reduc on in bone mass, whereas decrease in bone turnover is associated with preserva on of bone mass. Key words: Postmenopausal women, calcium and alkaline phosphatase INTRODUCTION The word ‘menopause’ is defi ned from the Greek words “meno” (month) and “paus’’ (to stop). Menopause is said to have occurred when menstrua on has ceased for twelve months.1 Menopause is defined as the permanent cessa on of menses resul ng from reduced ovarian hormone secre on that occurs naturally or is induced by surgery, chemotherapy, or radia on.2 Post-menopause is an estrogens deficient state. It applies to the whole of a woman’s life a er menopause.1 Menopause and ageing is associated with accelerated loss of cor cal bone. Bone loss occurs when the balance between forma on and resorp on is upset and resorp on is excessive resul ng in a nega ve remodelling balance.3 Osteoporosis is an important public health problem in older adults. It is more common in postmenopausal women and not only gives rise to morbidity but also markedly diminishes the quality of life in this popula on. There is lack of informa on about the risk factor of osteoporosis in developing countries.4 Serum alkaline phosphatase is the most commonly used marker of bone forma on. ALP is a ubiquitous enzyme that plays an important role in osteoid forma on and mineraliza on. The total ALP serum pool consists of several dimeric isoforms which originate from various ssues such as liver, bone, intes ne, spleen, kidney and placenta.5 Menopause is the permanent cessa on of menstrua on due to loss of ovarian follicular function, which results in decreased production of estradial and other hormones. Decreased levels of estrogen leads to increased osteoclast formationl and enchanced bone resorp on, which inturn leads to loss of bone density and destruc on of local architecture resul ng in microfractures.6 AIM OF THE STUDY: To evaluate the risk of accelerated bone loss by assessing bone markers like alkaline phosphatase (ALP) and calcium in postmenopausal women. MATERIALS AND METHODS The present study was carried out on 100 total subjects out of which experimental group consists of 50 subjects i.e Post menopausal women. Control group consists of 50 subjects Pre menopausal women. A total 50 post menopausal subjects were recruited for the study with the age group of >45 years for experimental group. Exclusion criteria were smokers, alcoholics and calcium supplement. A total 50 pre menopausal subjects were recruited for the study with the age group of 12-40 years for control group. Exclusion criteria were Pregnancy, Smokers, Alcoholics and Oral contracep ves. RESULTS The present study analyse the serum calcium level and ALP level in post menopausal women and compared with the pre menopausal women. The study was carried out on two groups of popula on, experimental 60 Journal of Lumbini Medical College group i.e. post menopausal women consisting of 50 females and control group i.e. pre menopausal women consis ng of 50 females. Exclusion criteria include smoking, consump on of alcohol, pregnancy, oral contraceptive administration and calcium supplementa on. Table 1: Comparison of mean values of Ca (mg/dl) and ALP (U/L) between Post and Pre Menopausal women Variable Post Menopausal Pre Menopausal Mean SD Mini Max Mean SD Mini Max Ca mg/dl 8.73 0.60 5.50 9.40 9.65 0.68 9.00 13.50 ALP U/L 111.86 66.56 41.00 414.00 82.40 78.50 21.00 550.00 Table 2: Test of signifi cance of mean values of Ca and ALP between post and Pre Menopausal women. Variable Post menopausal Pre menopausal P t Ca mg/dl 8.73 9.65 0.000 7.09* ALP U/L 111.86 82.4 0.046 2.03* *indicates 5 % level of signifi cance Table 1 and 2: shows that serum calcium were signifi cantly reduced in post menopause group mean (8.73±0.60) when compared to the pre menopause group mean (9.65±0.68) which shows a strong signifi cant of p=0.000, but both group values were within the normal reference range. Where as serum alkaline phosphatase (ALP) levels had a slight raise in post menopause group mean (111.86±66.5) when compared to the pre menopause group (82.40±78.50) showing only 5% signifi cant with p= 0.046, in these group also the values fall in the normal reference range. Table 3: shows a signifi cant nega ve co rela on between calcium and Alkaline phosphatase (r= -0.1496), where in serum Alkaline phosphatase levels are elevated whereas serum calcium levels are reduced in postmenopausal women. Table 3: Pearson correla on coeffi cient of serum calcium and serum ALP levels in post menopausal women. Correla on Coeffi cient Case (n=50) r value between calcium and ALP in post menopausal women -0.1496 Correlation coeffi cient between post Ca and post ALP = - 0.1496 DISCUSSION Menopause is associated with numerous physiological and biochemical changes affecting bone mineral metabolism. Results from various case control study on es ma on of serum calcium, inorganic phosphate, total proteins, albumin, alkaline phosphatase and acid phosphatise activities in pre and post menopausal women have shown that serum calcium levels of post menopausal women is not sta s cally signifi cant. This is in accordance with the fi ndings of Ashuma , Suresh and Naidu and Masse et.al who also reported higher levels of these parameters in post menopausal women.7-9 In the present study we had signifi cance in case and control means but s ll the values tend to remain in normal reference range. The serum calcium were signifi cantly reduced in post menopause group mean (8.73±0.60) when compared to the pre menopause group mean (9.65±0.68) which shows a strong signifi cant of p=0.000. Where as serum alkaline phosphatase (ALP) levels had a sight raise in post menopause group mean (111.86±66.5) when compared to the pre menopause group (82.40±78.50) showing only 5% signifi cant with p= 0.046. Ashuma et.al, said that ageing and menopause, leads to decline in estrogen and progesterone produc on which has been implicated in the increased levels of calcium in post menopausal women.7 It is well known that estrogen defi ciency induces synthesis of cytokines by osteoblast, monocytes and T cells and thereby s mulates bone resorp on by increasing osteoclas c ac vity. This results in modifi ca on of the reabsorp on, excre on and resorp on of calcium leading to increased circula ng levels of this ion.10-12 No signifi cant varia on was observed in serum levels of calcium and ALP in the various years since menopause group (YSM). However contrary to this fi nding higher calcium and ALP have been demonstrated in early post menopausal women (≤10 YSM) compared to late menopausal women (≤10 YSM).13 Bone is a connec ve ssue that provides mechanical support to the body vital organs and act as reservoir of calcium and phosphate as 99% of calcium and 85% of phosphate are present in skeleton. Peak bone mass is achieved during the third decade of life which gradually declines leading to osteopenia which predisposes to osteoporosis14. CONCLUSION In normal post menopausal women, an increase in bone turnover accelerates the reduc on in bone mass, whereas decrease in bone turnover is associated with preserva on of bone mass. In our present study serum calcium level and ALP levels were es mated in post 61 KR Joshi A et al menopausal women were es mated and compared with pre menopausal women. The comparison study reveals that the serum calcium were signifi cantly reduced in post menopause group mean when compared to the pre menopause group mean which shows a strong signifi cant of p=0.000. Whereas serum alkaline phosphatase (ALP) levels had a slightly raised in post menopause group mean when compared to the pre menopause group showing only 5% signifi cant with p= 0.046. 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