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Logo of annrheumdAnnals of the Rheumatic DiseasesVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
Ann Rheum Dis. 2003 April; 62(4): 332–336.
PMCID: PMC1754496

Cartilage turnover assessed with a newly developed assay measuring collagen type II degradation products: influence of age, sex, menopause, hormone replacement therapy, and body mass index


Background: Cartilage normally has a slow turnover but in arthritis increased metabolism results in degradation of the tissue.

Objective: To assess cartilage turnover in a sample of the general population by an assay measuring cartilage derived urinary collagen type II (CTX-II) C-telopeptide degradation products.

Methods: CTX-II concentrations were measured in urine samples from 615 healthy men and women aged 20–87 years, and the influence of age, sex, menopause, hormone replacement therapy (HRT), and body mass index (BMI) was assessed.

Results: CTX-II concentrations showed age dependent variations, with notable differences between men and women. Mean (SD) CTX-II concentration in postmenopausal women (220 (118) ng/mmol, n=25) was significantly higher than in an age matched group of premenopausal women (112 (79) ng/mmol, n=26, p<0.001). CTX-II concentration in women using HRT (118 (57) ng/mmol, n=50) was significantly lower than in an age and BMI matched group of women not receiving HRT (215 (99) ng/mmol, n=50, p<0.001). In subjects with a BMI ≥25 kg/m2, CTX-II concentrations were significantly higher than in those with a BMI <25 kg/m2 (185 (114) v 148 (91) ng/mmol, p<0.001).

Conclusions: Cartilage turnover, as assessed by measuring urinary degradation products of CTX-II varies considerably with age, and significant differences between CTX-II levels in men and women as well as in pre- and postmenopausal women are found. Further studies are required to validate the marker for assessing cartilage degradation in arthritis.

Figure 1
Age dependent variations in (A) creatinine corrected urinary CTX-II; (B) creatinine corrected urinary CTX-I; and (C) serum osteocalcin concentrations in women (open circle) and men (filled circle) aged 20–87. Results shown are means (SEM). Table ...
Figure 2
Influence of age and menopausal status on creatinine corrected urinary CTX-II concentrations in women. (A) A scatterplot presenting individual values of premenopausal (filled circle) and postmenopausal (open circle) women. (B) Influence of menopausal ...
Figure 3
(A) Influence of HRT on creatinine corrected urinary CTX-II concentrations independently of age and BMI. (B) Creatinine corrected urinary CTX-II concentrations in women having received HRT for 0–4 years and 4–10 years, respectively. Results ...
Figure 4
Influence of BMI on creatinine corrected urinary CTX-II concentrations in subjects older than 35 years of age. Results are adjusted for age and shown as mean with SEM. *p<0.001.

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