Bønløkke S E, Rand M S, Haddock B, Arup S, Smith C D, Jensen J E B, Schwarz P, Hovind P, Oturai P S, Jensen L T, Møller S, Eiken P, Rubin K H, Hitz M F, Abrahamsen B, Jørgensen N R
Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
Department of Clinical Biochemistry, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
Osteoporos Int. 2022 Oct;33(10):2155-2164. doi: 10.1007/s00198-022-06457-0. Epub 2022 Jun 21.
Anti-resorptive osteoporosis treatment might be more effective in patients with high bone turnover. In this registry study including clinical data, high pre-treatment bone turnover measured with biochemical markers was correlated with higher bone mineral density increases. Bone turnover markers may be useful tools to identify patients benefitting most from anti-resorptive treatment.
In randomized, controlled trials of bisphosphonates, high pre-treatment levels of bone turnover markers (BTM) were associated with a larger increase in bone mineral density (BMD). The purpose of this study was to examine this correlation in a real-world setting.
In this registry-based cohort study of osteoporosis patients (n = 158) receiving antiresorptive therapy, the association between pre-treatment levels of plasma C-telopeptide of type I Collagen (CTX) and/or N-terminal propeptide of type I procollagen (PINP) and change in bone mineral density (BMD) at lumbar spine, total hip, and femoral neck upon treatment was examined. Patients were grouped according to their pre-treatment BTM levels, defined as values above and below the geometric mean for premenopausal women.
Pre-treatment CTX correlated with annual increase in total hip BMD, where patients with CTX above the geometric mean experienced a larger annual increase in BMD (p = 0.008) than patients with CTX below the geometric mean. The numerical pre-treatment level of CTX showed a similar correlation at all three skeletal sites (total hip (p = 0.03), femoral neck (p = 0.04), and lumbar spine (p = 0.0003)). A similar association was found for PINP where pre-treatment levels of PINP above the geometric mean correlated with a larger annual increase in BMD for total hip (p = 0.02) and lumbar spine (p = 0.006).
Measurement of pre-treatment BTM levels predicts osteoporosis patients' response to antiresorptive treatment. Patients with high pre-treatment levels of CTX and/or PINP benefit more from antiresorptive treatment with larger increases in BMD than patients with lower pre-treatment levels.
抗吸收性骨质疏松症治疗可能对骨转换率高的患者更有效。在这项纳入临床数据的登记研究中，用生化标志物测量的治疗前高骨转换与更高的骨矿物质密度增加相关。骨转换标志物可能是识别最能从抗吸收治疗中获益患者的有用工具。
在双膦酸盐的随机对照试验中，治疗前骨转换标志物（BTM）水平高与骨矿物质密度（BMD）的更大增加相关。本研究的目的是在现实环境中检验这种相关性。
在这项基于登记的骨质疏松症患者队列研究中（n = 158），这些患者接受抗吸收治疗，研究了治疗前血浆I型胶原C端肽（CTX）和/或I型前胶原N端前肽（PINP）水平与腰椎、全髋和股骨颈治疗后骨矿物质密度（BMD）变化之间的关联。患者根据其治疗前BTM水平分组，定义为高于和低于绝经前女性几何平均值的值。
治疗前CTX与全髋BMD的年增加相关，CTX高于几何平均值的患者比CTX低于几何平均值的患者BMD年增加更大（p = 0.008）。CTX的治疗前数值水平在所有三个骨骼部位（全髋（p = 0.03）、股骨颈（p = 0.04）和腰椎（p = 0.0003））显示出类似的相关性。对于PINP也发现了类似的关联，PINP治疗前水平高于几何平均值与全髋（p = 0.02）和腰椎（p = 0.006）BMD的更大年增加相关。
测量治疗前BTM水平可预测骨质疏松症患者对抗吸收治疗的反应。治疗前CTX和/或PINP水平高的患者比治疗前水平低的患者从抗吸收治疗中获益更多，BMD增加更大。
