Academic Unit of Bone Metabolism, The Mellanby Centre for Bone Research, University of Sheffield, Sheffield, UK.
Centre for Integrated Research into Musculoskeletal Ageing, Liverpool, UK.
Osteoporos Int. 2019 Apr;30(4):917-922. doi: 10.1007/s00198-018-04823-5. Epub 2019 Jan 6.
Bone markers may be useful to monitor response to treatment withdrawal in osteoporosis. We used two criteria for investigating the change in BTMs after withdrawal of bisphosphonate treatment. A larger increase in BTMs was associated with greater bone loss. Bone markers may be useful in monitoring of patients taking a pause from treatment.
Measurement of bone turnover markers (BTMs) may be useful to monitor offset of treatment with bisphosphonates (BP) in osteoporosis. We assessed the effect of withdrawal of BP treatment by comparing the changes in BTMs and total hip (TH) bone density (BMD).
We studied postmenopausal osteoporotic women who had completed a randomised study of three oral BPs. After 2 years of treatment, participants with BMD T-score > - 2.5 and in whom it was considered clinically appropriate to discontinue treatment, were invited to participate in a further 2-year observational study. Biochemical response was assessed using BTMs (CTX and PINP) with offset being defined by two criteria: (1) an increase greater than the least significant change (LSC) and (2) an increase above the reference mean value.
Fifty women completed the study. At 48 weeks after stopping BPs, CTX was greater than the LSC for 66% of women and PINP 72%; CTX was above the reference mean for 64% of women and PINP 42%. The decrease in THBMD was greater for women with the largest increase in BTM compared to those with continued suppression (mean difference for CTX was - 2.98%, 95%CI - 4.75 to - 1.22, P < 0.001, PINP - 2.25%, 95% CI - 4.46 to - 0.032, P = 0.046).
The measurement of BTM after withdrawal of BPs is potentially useful to evaluate patients that are taking a pause from treatment. An increase in BTMs more than the LSC and/or reference mean reflects loss of treatment effect and identifies patients that are likely to have a decrease in BMD. Such changes could provide an indication for reintroduction of treatment.
骨标志物可用于监测骨质疏松症治疗停药后的反应。我们使用了两种标准来研究停药后 BTM 的变化。BTM 更大的增加与更大的骨丢失有关。骨标志物可能有助于监测暂停治疗的患者。
骨转换标志物（BTM）的测量可能有助于监测骨质疏松症中双膦酸盐（BP）治疗的消退。我们通过比较 BTM 和全髋（TH）骨密度（BMD）的变化来评估 BP 治疗停药的效果。
我们研究了完成了三种口服 BP 随机研究的绝经后骨质疏松女性。经过 2 年的治疗，BMD T 评分> -2.5 且临床认为可以停止治疗的参与者，被邀请参加进一步的 2 年观察研究。使用 BTM（CTX 和 PINP）评估生化反应，停药定义为两个标准：（1）增加大于最小显著变化（LSC）和（2）增加高于参考平均值。
50 名女性完成了研究。停止 BP 后 48 周时，CTX 大于 LSC 的女性占 66%，PINP 占 72%；CTX 高于参考平均值的女性占 64%，PINP 占 42%。与继续抑制相比，BTM 增加最大的女性 THBMD 下降更大（CTX 的平均差异为-2.98%，95%CI -4.75 至-1.22，P < 0.001，PINP -2.25%，95%CI -4.46 至-0.032，P = 0.046）。
BP 停药后 BTM 的测量可能有助于评估暂停治疗的患者。BTM 的增加大于 LSC 和/或参考平均值反映了治疗效果的丧失，并确定了可能出现 BMD 下降的患者。这些变化可能为重新开始治疗提供依据。
