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22907 NTX-Telopeptide, Urine (NTXPR)

NTX-Telopeptide, Urine (NTXPR)
Test Code: NTXSO
Synonyms/Keywords

​​Collagen Crosslinks, Crosslinked N-telopeptide of Type I Collagen (NTX), Urine, N-Telopeptide, Urine, NTX Creatinine, Osteomark, Osteoporosis, NTXPR, U NTXSO

Useful For

As an adjunct in the diagnosis of medical conditions associated with increased bone turnover

Monitoring effectiveness of antiresorptive therapy in patients treated for osteopenia, osteoporosis, Paget disease, or other metabolic bone disorders

Specimen Requirements
Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
Urine​ ​Clean, plastic urine collection container ​ ​4 mL 0.5  mL​ ​
Collection Processing Instructions

For 24 hours before specimen collection do not take multivitamins or dietary supplements containing biotin (vitamin B7), which is commonly found in hair, skin, and nail supplements and multivitamins.

1. Collect second morning void.
2. No preservative.

Specimen Stability Information
Specimen Type Temperature Time
​Urine ​ ​ ​Frozen (preferred) ​28 days
​Refrigerated ​14 days
​Ambient ​72 hours
Rejection Criteria

​Grossly Hemolyzed

Specimen with pH <5

Specimen containing preservatives

Interference

​Very dilute specimens may not allow measurement of a urine creatinine level and, therefore, reporting of N-terminal telopeptide (NTx) values normalized to creatinine becomes impossible. 

Inadvertent collection of urine for NTx measurements in a collection bottle that contains an acidic preservative results in substantial artifactual elevations of apparent NTx concentrations; such specimens are unacceptable and will be rejected.

Hemolysis and turbidity in samples may affect test results.

While the VITROS NTx test is used as an indicator of bone resorption, use of this test has not been established to predict development of osteoporosis or future fracture risk. A single NTx value cannot provide the rate of bone resorption as reported results do not contain a measure of time.

Use of this test has not been established in primary hyperparathyroidism or hyperthyroidism.

Biotin levels in urine remain elevated for up to 24 hours after oral or intravenous biotin administration.

Performing Laboratory Information
Performing Location Day(s) Test Performed Report Available
 Methodology/Instrumentation
Mayo Clinic Laboratories  Monday, Thursday ​Same day/1 to 5 days
NTXUR:  Chemiluminescence Immunoassay
NTXCT:  Enzymatic Colorimetric Assay
Reference Lab
Mayo Clinic Laboratories
Test Information
​

Human bone is continuously remodeled through a process of osteoclast-mediated bone formation and resorption. This process can be monitored by measuring serum and urine markers of bone formation and resorption. Approximately 90% of the organic matrix of bone is type I collagen, a helical protein that is cross-linked at the N- and C-terminal ends of the molecule. The amino acid sequences and orientation of the cross-linked alpha 2 N-telopeptide of type 1 collagen make it a specific marker of human bone resorption. N-terminal telopeptide (NTx) molecules are mobilized from bone by osteoclasts and subsequently excreted in the urine. Elevated levels of NTx indicate increased bone resorption.

Bone turnover markers are physiologically elevated during childhood, growth, and during fracture healing. The elevations in bone resorption markers and bone formation markers are typically balanced in these circumstances and of no diagnostic value. By contrast, abnormalities in the process of bone remodeling can result in changes in skeletal mass and shape. Many diseases, in particular hyperthyroidism, all forms of hyperparathyroidism, most forms of osteomalacia and rickets (even if not associated with hyperparathyroidism), hypercalcemia of malignancy, Paget disease, multiple myeloma, and bony metastases, as well as various congenital diseases of bone formation and remodeling can result in accelerated and unbalanced bone turnover. Unbalanced bone turnover, usually without increase in bone turnover, is also found in age-related and postmenopausal osteopenia and osteoporosis.

Disease-associated bone turnover abnormalities should normalize in response to effective therapeutic interventions, which can be monitored by measurement of serum and urine bone resorption and formation markers.

Reference Range Information

All units are reported in nmol bone collagen equivalents (BCE)/mmol creatinine.

Pediatric

Males:

Tanner Stage I: 55-508 nmol BCE/mmol creatinine

Tanner Stage II: 21-423 nmol BCE/mmol creatinine

Tanner Stage III: 27-462 nmol BCE/mmol creatinine

Tanner Stage IV: <609 nmol BCE/mmol creatinine

Tanner Stage V: <240 nmol BCE/mmol creatinine

 

Females:

Tanner Stage I: 6-662 nmol BCE/mmol creatinine

Tanner Stage II: 193-514 nmol BCE/mmol creatinine

Tanner Stage III: 13-632 nmol BCE/mmol creatinine

Tanner Stage IV: <389 nmol BCE/mmol creatinine

Tanner Stage V: <132 nmol BCE/mmol creatinine

 

Adult (> or =18 years of age)

Males:

21-83 nmol BCE/mmol creatinine

 

Females:

Premenopausal: 17-94 nmol BCE/mmol creatinine

Postmenopausal: 26-124 nmol BCE/mmol creatinine

Interpretation

Elevated levels of N-terminal telopeptide (NTx) indicate increased bone resorption. 

Most patients with osteopenia or osteoporosis have low, but unbalanced, bone turnover, with bone resorption dominating over bone formation. While this may result in mild elevations in bone turnover markers in these patients, finding significantly elevated urine NTx levels is atypical. Therefore, if levels are substantially elevated above the young adult reference range (>1.5- to 2-fold), the likelihood of coexisting osteomalacia, or of an alternative diagnosis as described in the Clinical Information section, should be considered.

When alternative causes for elevated NTx have been excluded in a patient with osteopenia/osteoporosis, the patient must be considered at increased risk for accelerated progression of osteopenia/osteoporosis.

A 30% or greater reduction in this resorption marker 3 to 6 months after initiation of therapy indicates a probably adequate therapeutic response.

The Negotiated Rulemaking Committee of Health Care Finance Administration also recommends:

"Because of significant specimen to specimen collagen crosslink physiologic variability (15%-20%), current recommendations for appropriate utilization include: 1 or 2 baseline assays from specified urine collections on separate days; followed by a repeat assay about 3 months after starting antiresorptive therapy; followed by a repeat assay in 12 months; thereafter not more than annually, if medically necessary."

 
Outreach CPTs
CPT Modifier
(if needed)		 Quantity Description Comments
​82523 ​ ​1 ​Collagen cross links, any method ​
​82570 ​ ​1 ​Creatinine, other source ​
Synonyms/Keywords

​​Collagen Crosslinks, Crosslinked N-telopeptide of Type I Collagen (NTX), Urine, N-Telopeptide, Urine, NTX Creatinine, Osteomark, Osteoporosis, NTXPR, U NTXSO

Ordering Applications
Ordering Application Description
​Cerner NTX-Telopeptide, Urine (NTXPR)
If the ordering application you are looking for is not listed, contact your local laboratory for assistance.
Specimen Requirements
Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
Urine​ ​Clean, plastic urine collection container ​ ​4 mL 0.5  mL​ ​
Collection Processing

For 24 hours before specimen collection do not take multivitamins or dietary supplements containing biotin (vitamin B7), which is commonly found in hair, skin, and nail supplements and multivitamins.

1. Collect second morning void.
2. No preservative.

Specimen Stability Information
Specimen Type Temperature Time
​Urine ​ ​ ​Frozen (preferred) ​28 days
​Refrigerated ​14 days
​Ambient ​72 hours
Rejection Criteria

​Grossly Hemolyzed

Specimen with pH <5

Specimen containing preservatives

Interference

​Very dilute specimens may not allow measurement of a urine creatinine level and, therefore, reporting of N-terminal telopeptide (NTx) values normalized to creatinine becomes impossible. 

Inadvertent collection of urine for NTx measurements in a collection bottle that contains an acidic preservative results in substantial artifactual elevations of apparent NTx concentrations; such specimens are unacceptable and will be rejected.

Hemolysis and turbidity in samples may affect test results.

While the VITROS NTx test is used as an indicator of bone resorption, use of this test has not been established to predict development of osteoporosis or future fracture risk. A single NTx value cannot provide the rate of bone resorption as reported results do not contain a measure of time.

Use of this test has not been established in primary hyperparathyroidism or hyperthyroidism.

Biotin levels in urine remain elevated for up to 24 hours after oral or intravenous biotin administration.

Useful For

As an adjunct in the diagnosis of medical conditions associated with increased bone turnover

Monitoring effectiveness of antiresorptive therapy in patients treated for osteopenia, osteoporosis, Paget disease, or other metabolic bone disorders

Reference Range Information

All units are reported in nmol bone collagen equivalents (BCE)/mmol creatinine.

Pediatric

Males:

Tanner Stage I: 55-508 nmol BCE/mmol creatinine

Tanner Stage II: 21-423 nmol BCE/mmol creatinine

Tanner Stage III: 27-462 nmol BCE/mmol creatinine

Tanner Stage IV: <609 nmol BCE/mmol creatinine

Tanner Stage V: <240 nmol BCE/mmol creatinine

 

Females:

Tanner Stage I: 6-662 nmol BCE/mmol creatinine

Tanner Stage II: 193-514 nmol BCE/mmol creatinine

Tanner Stage III: 13-632 nmol BCE/mmol creatinine

Tanner Stage IV: <389 nmol BCE/mmol creatinine

Tanner Stage V: <132 nmol BCE/mmol creatinine

 

Adult (> or =18 years of age)

Males:

21-83 nmol BCE/mmol creatinine

 

Females:

Premenopausal: 17-94 nmol BCE/mmol creatinine

Postmenopausal: 26-124 nmol BCE/mmol creatinine

Interpretation

Elevated levels of N-terminal telopeptide (NTx) indicate increased bone resorption. 

Most patients with osteopenia or osteoporosis have low, but unbalanced, bone turnover, with bone resorption dominating over bone formation. While this may result in mild elevations in bone turnover markers in these patients, finding significantly elevated urine NTx levels is atypical. Therefore, if levels are substantially elevated above the young adult reference range (>1.5- to 2-fold), the likelihood of coexisting osteomalacia, or of an alternative diagnosis as described in the Clinical Information section, should be considered.

When alternative causes for elevated NTx have been excluded in a patient with osteopenia/osteoporosis, the patient must be considered at increased risk for accelerated progression of osteopenia/osteoporosis.

A 30% or greater reduction in this resorption marker 3 to 6 months after initiation of therapy indicates a probably adequate therapeutic response.

The Negotiated Rulemaking Committee of Health Care Finance Administration also recommends:

"Because of significant specimen to specimen collagen crosslink physiologic variability (15%-20%), current recommendations for appropriate utilization include: 1 or 2 baseline assays from specified urine collections on separate days; followed by a repeat assay about 3 months after starting antiresorptive therapy; followed by a repeat assay in 12 months; thereafter not more than annually, if medically necessary."

 
For more information visit:
Performing Laboratory Information
Performing Location Day(s) Test Performed Report Available
 Methodology/Instrumentation
Mayo Clinic Laboratories  Monday, Thursday ​Same day/1 to 5 days
NTXUR:  Chemiluminescence Immunoassay
NTXCT:  Enzymatic Colorimetric Assay
Reference Lab
Mayo Clinic Laboratories
For billing questions, see Contacts
Outreach CPTs
CPT Modifier
(if needed)		 Quantity Description Comments
​82523 ​ ​1 ​Collagen cross links, any method ​
​82570 ​ ​1 ​Creatinine, other source ​
For most current information refer to the Marshfield Laboratory online reference manual.