Abstract

Introduction: Cathepsin K, a cysteine protease, plays an essential role in osteoclast-mediated collagen degradation. Recently, an immunoassay to quantify cathepsin K in serum has been developed. We assessed the usefulness of serum cathepsin K as a marker of bone turnover in cross-sectional and longitudinal studies of patients with metabolic bone disease.
Methods: The study cohort consisted of 40 healthy subjects, 21 women with postmenopausal osteoporosis [66.1±7.9 yrs] and 10 patients with Paget’s disease of bone [67.1±11.6 yrs]. All patients were started on oral or intravenous bisphosphonate treatment and were followed prospectively over 6 months. Circulating cathepsin K levels were determined by a specific sandwich enzyme immunoassay (Biomedica, Vienna, Austria). In addition, serum carb- oxyterminal cross-linked telopeptide of type I collagen (βCTX-I) and bone-specific alkaline phosphatase (BALP) were measured for comparison.
Results: When compared to healthy subjects, mean serum cathepsin K levels were significantly elevated in women with postmenopausal osteoporosis (3.1 ± 1.9 vs. 11.3 ± 13.1 pmol/L, p=0.01) and in patients with Paget’s disease of bone (6.2 ± 4.4 pmol/L, p=0.04). In postmenopausal osteoporotic women, both oral and intravenous bisphosphonate treatment resulted in a significant reduction in serum cathepsin K levels (p=0.03) with most of the effect occurring after one month (mean% change: -33%). In patients with mild Paget’s disease, serum cathepsin K levels decreased during bisphosphonate treatment.
Conclusions: Serum concentrations of cathepsin K appear to reflect osteoclastic activity in patients with postmenopausal osteoporosis and Paget’s disease of bone and may hold promise as a marker of osteoclast activity.

DOI: Clin. Lab. 2006;52:1-10