Department of Orthopedic Surgery, Enshu Hospital, 1-1-1 Chuo, Naka-ku, Hamamatsu, Shizuoka, 430-0929, Japan.
Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.
J Bone Miner Metab. 2019 Mar;37(2):319-326. doi: 10.1007/s00774-018-0920-5. Epub 2018 Mar 30.
Serum homocysteine is a possible marker to indicate bone quality. However, it is not clear whether changes are seen in serum homocysteine levels with long-term bisphosphonate therapy. We aimed to investigate the factors affecting serum homocysteine levels during a 3-year period of monthly minodronate therapy in osteoporotic women, and to examine if the serum homocysteine levels could reflect some aspects of bone metabolism. The study included 43 patients (age 72.3 ± 7.0 years) undergoing treatment for osteoporosis for the first time (New group) and 35 patients (age 74.4 ± 8.2 years) who switched from alendronate or risedronate to minodronate (Switch group). Minodronate (50 mg/every 4 weeks) was administered for 36 months. Lumbar, femoral neck, and total hip bone mineral densities (BMD), and serum homocysteine levels were monitored at baseline and after 9, 18, 27, and 36 months of treatment. Lumbar BMD increased significantly in both groups (New group 11.4%, Switch group 6.2%). However, femoral neck and total hip BMDs increased only in the New group (femoral neck 3.6%, total hip 4.1%). Serum homocysteine levels increased significantly at 18 and 27 months in all subjects. Multiple linear regression analysis revealed that changes in homocysteine levels during 18, 27, and 36 months significantly correlated with changes in creatinine clearance during the same corresponding periods (18 months: B = - 0.472, p = 0.003; 27 months: B = - 0.375, p = 0.021; 36 months: B = - 0.445, p = 0.012). Thus, serum homocysteine levels possibly reflect renal function instead of bone metabolism during minodronate therapy.
血清同型半胱氨酸可能是反映骨质量的一个标志物。然而，目前尚不清楚长期使用双膦酸盐治疗是否会导致血清同型半胱氨酸水平发生变化。我们旨在研究在骨质疏松女性接受每月米诺膦酸盐治疗 3 年期间，影响血清同型半胱氨酸水平的因素，并探讨血清同型半胱氨酸水平是否能反映骨代谢的某些方面。该研究纳入了 43 名（年龄 72.3±7.0 岁）初次接受骨质疏松治疗的患者（新组）和 35 名（年龄 74.4±8.2 岁）从阿仑膦酸钠或利塞膦酸钠转换为米诺膦酸盐的患者（转换组）。米诺膦酸盐（50mg/每 4 周）治疗 36 个月。在基线和治疗 9、18、27 和 36 个月时，监测腰椎、股骨颈和全髋骨密度（BMD）和血清同型半胱氨酸水平。两组的腰椎 BMD 均显著增加（新组 11.4%，转换组 6.2%）。然而，只有新组的股骨颈和全髋 BMD 增加（股骨颈 3.6%，全髋 4.1%）。所有患者的血清同型半胱氨酸水平在 18 和 27 个月时均显著升高。多元线性回归分析显示，18、27 和 36 个月期间同型半胱氨酸水平的变化与同期肌酐清除率的变化显著相关（18 个月：B=-0.472，p=0.003；27 个月：B=-0.375，p=0.021；36 个月：B=-0.445，p=0.012）。因此，在米诺膦酸盐治疗期间，血清同型半胱氨酸水平可能反映肾功能而非骨代谢。
