Department of Medicine, University of California, San Francisco, CA 94115, USA.
J Clin Densitom. 2011 Jan-Mar;14(1):68-73. doi: 10.1016/j.jocd.2010.09.001. Epub 2010 Nov 20.
We investigated whether those who experience the greatest increases in bone turnover in response to parathyroid hormone (PTH) therapy are the same as those who experience elevations in calcium levels. Baseline and follow-up procollagen type I N propeptide (PINP), bone-specific alkaline phosphatase (BAP), C-terminal telopeptide (CTX), and serum and urinary calcium levels were analyzed post hoc from the 119 postmenopausal women with osteoporosis randomized to PTH(1-84) in the Parathyroid Hormone and Alendronate trial. Short-term changes in the markers of bone turnover were highly correlated with one another (r=0.57-0.87, p<0.001). In contrast, change in serum calcium correlated only modestly with changes in markers of formation (r=0.22-0.30, p≤0.02) and did not correlate significantly with change in CTX (r=0.13, p=0.18). Participants who experienced hypercalcemia experienced greater 3-mo changes in BAP than those who did not (78% vs. 42% increase in BAP, p=0.04), with similar trends for PINP and CTX. In conclusion, the use of 1 marker of bone turnover, rather than multiple markers, may be sufficient to assess biochemical response to PTH(1-84). The relationship between bone turnover marker and calcium responses to PTH(1-84) is modest and does not suggest a profound, broadly heightened responsiveness of certain individuals to therapy.
我们研究了甲状旁腺激素（PTH）治疗后骨转换增加最大的患者是否与血钙升高的患者相同。从接受甲状旁腺激素 1-84（PTH（1-84））治疗的 119 名绝经后骨质疏松症女性中，按事后分析了基线和随访时的 I 型前胶原 N 端前肽（PINP）、骨碱性磷酸酶（BAP）、C 端肽（CTX）、血清和尿钙水平。骨转换标志物的短期变化彼此高度相关（r=0.57-0.87，p<0.001）。相比之下，血清钙的变化仅与形成标志物的变化中度相关（r=0.22-0.30，p≤0.02），与 CTX 的变化无显著相关性（r=0.13，p=0.18）。发生高钙血症的患者，BAP 在 3 个月时的变化大于未发生高钙血症的患者（BAP 增加 78%比增加 42%，p=0.04），PINP 和 CTX 也有类似趋势。总之，使用 1 种骨转换标志物，而不是多种标志物，可能足以评估对 PTH（1-84）的生化反应。骨转换标志物与 PTH（1-84）钙反应之间的关系是适度的，这并不表明某些个体对治疗有明显、广泛的高反应性。
