What does it mean if your osteocalcin serum is low (8) and you have a fracture that won't heal? Have any other patients had this reported in their blood tests?
My bones have been hurting more lately and a metabolic bone specialist ran this test. Thanks!
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8oclockcoffee - Name: Brenda
- Who do you know with myeloma?: Myself, Father, Aunt, and Grandfather
- When were you/they diagnosed?: 08-2013
- Age at diagnosis: 47
Re: Serum osteocalcin is low (8) - what does it mean?
Hi Brenda,
Sorry to hear about your fracture that won't heal.
My understanding is that osteocalcin is usually a sign of how much the body is doing to build up the bones in the body. When serum osteocalcin levels are low, something (such as myeloma) is limiting the ability of the body to build up the material in the bones.
So your low osteocalcin level is another reflection of what you've seen in the long time it is taking your fracture to heal.
My bottom line would be that the test result doesn't tell you much more than you already know, which is that something -- perhaps (probably?) your myeloma -- is interfering with the ability of your fracture to heal.
Here are a couple of resources with information that I found helpful in understanding what the osteocalcin test result means in myeloma patients:
Gosta Gahrton, Brian Durie, and Diana Samson, "Multiple Myeloma and Related Disorders", 2004:
There are additional mentions of osteocalcin in the book which can be found through this link.
O Mejjad et al, "Osteocalcin is not a marker of progress in multiple myeloma. Le Groupe d'Etude et de Recherche sur le Myélome (GERM)", European Journal of Haematology, 1996 (link to abstract at PubMed)
Also, the Mayo Clinic Laboratories has some information on the test that you may find useful, although I'll say that I found it seemed to contradict, at times, the information I found in other sources.
Sorry to hear about your fracture that won't heal.
My understanding is that osteocalcin is usually a sign of how much the body is doing to build up the bones in the body. When serum osteocalcin levels are low, something (such as myeloma) is limiting the ability of the body to build up the material in the bones.
So your low osteocalcin level is another reflection of what you've seen in the long time it is taking your fracture to heal.
My bottom line would be that the test result doesn't tell you much more than you already know, which is that something -- perhaps (probably?) your myeloma -- is interfering with the ability of your fracture to heal.
Here are a couple of resources with information that I found helpful in understanding what the osteocalcin test result means in myeloma patients:
Gosta Gahrton, Brian Durie, and Diana Samson, "Multiple Myeloma and Related Disorders", 2004:
In myeloma patients, measurements of osteocalcin (bone GLA protein) a marker of bone formation show a large scatter. Serum osteocalcin is usually decreased in myeloma patients with advanced disease and more extensive bone lesions consistent with the impaired bone formation. By contrast, serum osteocalcin levels may be normal or even increased earlier in the disease and in patients who have less aggressive or no obvious bone disease."
(link to page with above text)
There are additional mentions of osteocalcin in the book which can be found through this link.
O Mejjad et al, "Osteocalcin is not a marker of progress in multiple myeloma. Le Groupe d'Etude et de Recherche sur le Myélome (GERM)", European Journal of Haematology, 1996 (link to abstract at PubMed)
Lowest OC [osteocalcin] levels were observed when lytic bone lesions increased (p<0.05). There was no relationship between serum OC levels and vertebral crush fractures, serum calcium concentrations or stage of multiple myeloma, neither was there any relationship between initial serum OC levels and survival. Progression of the disease was associated with a clear fall of serum OC in 61.5% of the "progressive" patients, versus 41% of the persisting "stabilized" cases. Serum OC level was strongly correlated with bone formation (p = 0.005), but not with bone resorption. Serum OC level is a sensitive marker of osteoblast activity, but a poor marker of the severity of multiple myeloma. We do not consider it as a marker of multiple myeloma activity or prognosis."
Also, the Mayo Clinic Laboratories has some information on the test that you may find useful, although I'll say that I found it seemed to contradict, at times, the information I found in other sources.
Re: Serum osteocalcin is low (8) - what does it mean?
Thanks for the reply and helpful links. This makes more sense now.
I see my doctor on Monday to find out what she thinks the next step should be.
I just want to be able to walk without crutches again!
Brenda
I see my doctor on Monday to find out what she thinks the next step should be.
I just want to be able to walk without crutches again!
Brenda
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8oclockcoffee - Name: Brenda
- Who do you know with myeloma?: Myself, Father, Aunt, and Grandfather
- When were you/they diagnosed?: 08-2013
- Age at diagnosis: 47
Re: Serum osteocalcin is low (8) - what does it mean?
The question that I have is, "Are you on a bisphosphonate, Aredia or Zometa, now?"
When I had a pathologic fracture in my left arm from the myeloma, I was immediately started on treatment. I was watch and wait up to that point, and started on Zometa.
Also, are you on any treatment for the myleoma at this point?
When I started treatment and the Zometa, the pain from the fracture quickly began to diminish. I also had good bone healing by 3 months. Although the x-ray report said that it was 'healing', not 'healed'. At 5 months it was healed enough that my orthopedist discontinued me from further follow-up appointments. He was surprised that my arm healed at all. He also recommended that I see an oncological orthopedist because I had told him that I had lesions in my pelvis and femurs when he asked.
I hope that you and the doctors who you are consulting with figure out what is going on and why your fracture hasn't been healing.
Nancy in Phila
When I had a pathologic fracture in my left arm from the myeloma, I was immediately started on treatment. I was watch and wait up to that point, and started on Zometa.
Also, are you on any treatment for the myleoma at this point?
When I started treatment and the Zometa, the pain from the fracture quickly began to diminish. I also had good bone healing by 3 months. Although the x-ray report said that it was 'healing', not 'healed'. At 5 months it was healed enough that my orthopedist discontinued me from further follow-up appointments. He was surprised that my arm healed at all. He also recommended that I see an oncological orthopedist because I had told him that I had lesions in my pelvis and femurs when he asked.
I hope that you and the doctors who you are consulting with figure out what is going on and why your fracture hasn't been healing.
Nancy in Phila
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NStewart - Name: Nancy Stewart
- Who do you know with myeloma?: self
- When were you/they diagnosed?: 3/08
- Age at diagnosis: 60
Re: Serum osteocalcin is low (8) - what does it mean?
Hi Nancy,
No, I am not on bisphosphonates. I can't get a doctor to prescribe it.
My fracture was found by a rheumatologist after I had been complaining for two months that my ankle/leg was swollen. She sent me for an MRI where they found an 8 cm [3 inch] fracture.
She told me to call my myeloma specialist after they found the fracture in my tibia, but he said, "this fracture has nothing to do with myeloma." So my rheumatologist found me an orthopedic oncologist who said this was very suspicious. I underwent a tibia bone biopsy (ouch!) that came back negative for cancer.
My ortho then said that the fracture was non-union. I asked her about bisphosphonates and she said to call my PCP. I called my PCP and he said to call my myeloma specialist. Ugh!
I saw my "myeloma specialist" two weeks ago and again he said that my fracture (I am in crutches and a boot) had nothing to do with my myeloma. I asked him how he could determine that since myeloma does weaken bone, but didn't get an answer. He told me he would talk to the doctor who did the Dexa bone scan I asked for in December, but he never followed through.
I decided to call the doctor who did the bone scan and got right in. I told her I wanted bisphosphonates to help strengthen my bones because I can't live with another fracture. She ordered lots of blood tests where I see that I am low in oscteocalcin, but my vitamin D and calcium levels are normal.
I am exhausted and the bone pain is increasing. I don't know how much longer I can take this.
I am waiting for a call from my doctor to find out what she suggests after these tests have come in.
FYI - I do not have active multiple myeloma. I am MGUS / smoldering myeloma.
I had 10% plasma cells in my BMB last July. My M-spike is 2.2 g/dL (22 g/L) IgG kappa and my FLC keeps rising.
FLC ratio is 14.94(H) - 61.86% increase in 3 months
Kappa FLC is 12.1(H) - 70% increase in 3 months
Lambda FLC is 0.81
I don't understand the run around with bisphosphonates.
No, I am not on bisphosphonates. I can't get a doctor to prescribe it.
My fracture was found by a rheumatologist after I had been complaining for two months that my ankle/leg was swollen. She sent me for an MRI where they found an 8 cm [3 inch] fracture.
She told me to call my myeloma specialist after they found the fracture in my tibia, but he said, "this fracture has nothing to do with myeloma." So my rheumatologist found me an orthopedic oncologist who said this was very suspicious. I underwent a tibia bone biopsy (ouch!) that came back negative for cancer.
My ortho then said that the fracture was non-union. I asked her about bisphosphonates and she said to call my PCP. I called my PCP and he said to call my myeloma specialist. Ugh!
I saw my "myeloma specialist" two weeks ago and again he said that my fracture (I am in crutches and a boot) had nothing to do with my myeloma. I asked him how he could determine that since myeloma does weaken bone, but didn't get an answer. He told me he would talk to the doctor who did the Dexa bone scan I asked for in December, but he never followed through.
I decided to call the doctor who did the bone scan and got right in. I told her I wanted bisphosphonates to help strengthen my bones because I can't live with another fracture. She ordered lots of blood tests where I see that I am low in oscteocalcin, but my vitamin D and calcium levels are normal.
I am exhausted and the bone pain is increasing. I don't know how much longer I can take this.
I am waiting for a call from my doctor to find out what she suggests after these tests have come in.
FYI - I do not have active multiple myeloma. I am MGUS / smoldering myeloma.
I had 10% plasma cells in my BMB last July. My M-spike is 2.2 g/dL (22 g/L) IgG kappa and my FLC keeps rising.
FLC ratio is 14.94(H) - 61.86% increase in 3 months
Kappa FLC is 12.1(H) - 70% increase in 3 months
Lambda FLC is 0.81
I don't understand the run around with bisphosphonates.
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8oclockcoffee - Name: Brenda
- Who do you know with myeloma?: Myself, Father, Aunt, and Grandfather
- When were you/they diagnosed?: 08-2013
- Age at diagnosis: 47
Re: Serum osteocalcin is low (8) - what does it mean?
Hi Brenda,
It seems like a PET scan might be worth doing to answer the question of whether your fracture is myeloma-related or not. Another bone marrow biopsy might also be helpful in determining whether you've progressed from MGUS / smoldering to symptomatic multiple myeloma at this point.
Best wishes and keep us posted.
Mike
It seems like a PET scan might be worth doing to answer the question of whether your fracture is myeloma-related or not. Another bone marrow biopsy might also be helpful in determining whether you've progressed from MGUS / smoldering to symptomatic multiple myeloma at this point.
Best wishes and keep us posted.
Mike
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mikeb - Name: mikeb
- Who do you know with myeloma?: self
- When were you/they diagnosed?: 2009 (MGUS at that time)
- Age at diagnosis: 55
Re: Serum osteocalcin is low (8) - what does it mean?
Thanks, Mike. I was thinking the same thing. I had a PET Scan in 2013.
I was wondering what the recommended time between scans would be. Has anyone had the PET repeated in 24 months?
I will talk to my bone mineral doctor on Monday. I don't know her opinion yet on my blood tests, but she did say that she would recommend a bone biopsy if these tests weren't what she expected.
I told her - no problem - I had two and it was not a big deal. She replied this would be a little more invasive. It is a bone biopsy of my hip where they take a section of cortical bone and trabecular bone out and study the make up of the bone. Sounds interesting, and a little painful, but I will do it if it will prevent me from breaking another bone.
By the way, a tibial biopsy isn't very fun either. They used a drill to make a hole in my bone. They pushed so hard my leg was squishing on the pillow they had underneath it. All I could think is, "This is gonna hurt when the numbness wears off." It has been 2 months and still hasn't healed. There is still a large lump with calcification on my shin. It is not very pretty and hard to shave around too!
I was wondering what the recommended time between scans would be. Has anyone had the PET repeated in 24 months?
I will talk to my bone mineral doctor on Monday. I don't know her opinion yet on my blood tests, but she did say that she would recommend a bone biopsy if these tests weren't what she expected.
I told her - no problem - I had two and it was not a big deal. She replied this would be a little more invasive. It is a bone biopsy of my hip where they take a section of cortical bone and trabecular bone out and study the make up of the bone. Sounds interesting, and a little painful, but I will do it if it will prevent me from breaking another bone.
By the way, a tibial biopsy isn't very fun either. They used a drill to make a hole in my bone. They pushed so hard my leg was squishing on the pillow they had underneath it. All I could think is, "This is gonna hurt when the numbness wears off." It has been 2 months and still hasn't healed. There is still a large lump with calcification on my shin. It is not very pretty and hard to shave around too!
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8oclockcoffee - Name: Brenda
- Who do you know with myeloma?: Myself, Father, Aunt, and Grandfather
- When were you/they diagnosed?: 08-2013
- Age at diagnosis: 47
Re: Serum osteocalcin is low (8) - what does it mean?
Hi again Brenda,
In answer to your question about frequency of PET scans, I had 2 within a period of about 30 months when it looked (correctly) like my myeloma was progressing from smoldering to symptomatic. I'm not sure about other folks...
That tibial biopsy does not sound like fun. I hope it does eventually (and soon) all heal up for you.
Good luck with your doctor appointment Monday. Please keep us posted on how things go.
Mike
In answer to your question about frequency of PET scans, I had 2 within a period of about 30 months when it looked (correctly) like my myeloma was progressing from smoldering to symptomatic. I'm not sure about other folks...
That tibial biopsy does not sound like fun. I hope it does eventually (and soon) all heal up for you.
Good luck with your doctor appointment Monday. Please keep us posted on how things go.
Mike
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mikeb - Name: mikeb
- Who do you know with myeloma?: self
- When were you/they diagnosed?: 2009 (MGUS at that time)
- Age at diagnosis: 55
8 posts
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