BIOMARKERS OF BONE FORMATION AND RESORPTION
IN SKELETAL FLUOROSIS
Chatpat Kongpun,a,* Rungsiri Chotipatiwejchakool,b Phenphichar Wanachantararak,c Supoj Chamnarnprai,a
Jumpol Promsaka Na Sakon Nakorna
Chiang Mai, Thailand
SUMMARY: The aims of the present study were to study the presence of skeletal fluorosis, various
serum biomarkers of bone turnover and remodeling, and the urinary fluoride (F) levels in 57 elderly
persons who had lived in the high Doi Saket district for more than 10 years with a life-time use of
high-F water (n=40) or low-F water (n=17). The subjects were examined for the signs and symptoms
of skeletal fluorosis. Serum markers were measured for bone formation (alkaline phosphatase, total
P1 NP and osteocalcin) and bone resorption (β-isomerized C-terminal telopeptides (β-CTx) or beta
crosslaps, calcium, and phosphorus). The results showed that when the high-F and low-F groups
were compared, there was an increase in osteocalcin in the high-F group but no significant
differences in the serum levels of calcium, phosphorus, beta crosslaps, total P1NP, or alkaline
phosphatase. A non-significant trend was present for an increased level of beta crosslaps in the
high-F group, suggesting that bone resorption might be abnormal in this group and lead to bone
deformities. The F intake was significantly related to the serum phosphorus, the total P1NP, and the
osteocalcin. Moreover, the urinary F level and the urinary F to creatinine ratio were significantly
related to the total P1NP (r=0.385) and the osteocalcin (r=0.399). The use of high-F water for
drinking and cooking was considered to stimulate and increase abnormal bone formation with a
significant increase in the bone formation marker osteocalcin. A non-significant trend was present
for the total P1NP and the osteocalcin levels to be associated with the presence of grade 1 or 2
skeletal fluorosis.
Keywords: Alkaline phosphatase; β-isomerized C-terminal telopeptides (β-CTx); Beta crosslaps; Bone deformity;
Bone disease; Bone formation; Bone resorption; Calcium; Fluoride; Fluorosis; Osteocalcin; Phosphorus; Skeletal
fluorosis; Total P1NP; Urine fluoride.
aIntercountry
Centre for Oral Health, Department of Health, Ministry of Public Health, Thailand; bClinical
Chemistry Science, Department of Medical Technology, Faculty of Associated Medical Science, Chiang Mai
University; cThe Dental Research Center, Faculty of Dentistry, Chiang Mai University. *For correspondence:
Chatpat Kongpun, E-mail: chatpat.k@anamai.mail.go.th