Total Procollagen Type-1 N-Terminal Propeptide/Procollagen Extension Peptide (P1NP)

Clinical Chemistry

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Description

P1NP is a marker of bone formation. P1NP is released when type 1 collagen is formed from procollagen. Causes of increased P1NP ( bone causes ): 1. Recent fracture ( the increase is dependent on the size of the bone fractured ) 2. Untreated hyperthyroidism 3. Vitamin D deficiency 4. Paget's disease 5. Metastatic bone disease 6. Hyperparathyroidism 7. Teriparatide treatment Causes of low P1NP ( bone causes ) 1. Bisphosphonate and denosumab treatment 2. Adynamic bone disease Since the liver and skin also contain type I collagen, various liver or skin conditions may cause in increase in PINP. Steroid therapy ( >15mg prednisolone od ) causes a decrease in PINP, and therefore cannot be used for monitoring purposes in this situation. If further information on the clinical interpretation of PINP is required please contact the Metabolic Bone Unit.

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Indications

1. Monitoring of bisphosphonate and denosumab therapy. 2. Monitoring of teriparatide therapy. In bisphosphonate monitoring measure P1NP at baseline and at 6 months.

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Sample Type

Serum. SST/Gel. Minimum 2ml ( 1ml separated serum ).

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Reference Range

BISPHOSPHONATE MONITORING Baseline: >80 ug/L - unless recent fracture, seek cause of high bone turnover. Response at 6 months: Good: <35 ug/L and/or fall >10 ug/L Suboptimal: >35 ug/L and fall <10 ug/L PINP can be increased in renal, liver and skin disease and decreased by high dose steroids ( >15mg prednisolone/day ). For further details see guideline.

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Turnaround Time

Within 1 day

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Testing Frequency

As required

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Patient Preparation

None. The measurement of P1NP shows minimal circadian rhythm or seasonal variation, and food intake or diet show no significant influence on plasma concentrations

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