Odense Patient Exploratory Network, University of Southern Denmark, Odense, Denmark.
Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark.
Osteoporos Int. 2019 Dec;30(12):2381-2389. doi: 10.1007/s00198-019-05132-1. Epub 2019 Aug 24.
To assess the time from fracture until bone turnover markers (BTM), which are biochemical markers reflecting in vivo bone formation and resorptive activity, have returned to a stable level since BTM have been shown to be at least as good as bone mineral density in monitoring the effect of anti-resorptive treatment in osteoporosis. This study searched for articles in PUBMED, CINAHL, Medline, EM-BASE, and Cochrane, and identified 3486 unique articles. These articles were screened based on predefined inclusion and exclusion criteria. Seven articles addressing time to normalization of either CTX, PINP, osteocalcin, or bone-specific alkaline phosphatase after a recent fracture were identified and these were analyzed qualitatively. CTX appeared to return to baseline within 6 months. PINP appeared to return to baseline within 6 months and interestingly dip below baseline after a year. Osteocalcin was elevated throughout the first year after a fracture, with most changes in the first 6 months. Bone-specific alkaline phosphatase (BAP) was increased for up to a year, however with a discrepancy between used assays. Seven studies were identified, showing CTX and PINP to return to baseline within 6 months. OC was elevated for 12 months. BAP was increased for up to a year. However, none of these studies had fasting patients and a long follow-up period with regular measurements. The studies could indicate that the BTM CTX and PINP have returned to baseline within 6 months; however, further studies are needed assessing pre-analytical factors while having a long follow-up. Bone turnover markers appear as good as or better than bone mineral density in monitoring the effect of anti-resorptive medication in osteoporosis. This study tries to identify the time from fracture until BTM are back at baseline. Most studies did not however take pre-analytical variation into consideration. Further research is therefore needed.
为了评估骨折后骨转换标志物（BTM）恢复至稳定水平所需的时间，因为 BTM 在监测骨质疏松症抗吸收药物治疗效果方面至少与骨密度一样好，所以已经证明 BTM 是反映体内骨形成和吸收活性的生化标志物。本研究在 PUBMED、CINAHL、Medline、EM-BASE 和 Cochrane 中搜索了文章，并确定了 3486 篇独特的文章。这些文章根据预先设定的纳入和排除标准进行了筛选。确定了 7 篇文章，这些文章均探讨了近期骨折后 CTX、PINP、骨钙素或骨特异性碱性磷酸酶恢复正常的时间，并对这些文章进行了定性分析。CTX 似乎在 6 个月内恢复到基线水平。PINP 似乎在 6 个月内恢复到基线水平，并且在 1 年后有趣地低于基线。骨折后第一年骨钙素一直升高，前 6 个月变化最大。骨特异性碱性磷酸酶（BAP）在一年内增加，但使用的检测方法之间存在差异。确定了 7 项研究，结果表明 CTX 和 PINP 在 6 个月内恢复到基线。OC 在 12 个月内升高。BAP 增加了 1 年。然而，这些研究都没有让患者空腹，并且没有进行长期随访和定期测量。这些研究表明，BTM CTX 和 PINP 在 6 个月内恢复到基线；然而，需要进一步的研究来评估分析前因素，同时进行长期随访。骨转换标志物在监测骨质疏松症抗吸收药物治疗效果方面与骨密度一样好，甚至更好。本研究试图确定从骨折到 BTM 恢复到基线的时间。然而，大多数研究并没有考虑分析前的变化。因此，需要进一步的研究。
