Differences in the Capacity of Several Biochemical Bone Markers to Assess High Bone Turnover in Early Menopause and Response to Alendronate Therapy |
| |
Authors: | E Fink C Cormier P Steinmetz C Kindermans Y Le Bouc and J-C Souberbielle |
| |
Institution: | (1) Laboratoire de Physiologie, H?pital Necker-Enfants Malades (AP-HP), Paris, FR;(2) Laboratoire de Physiologie, H?pital A Trousseau (AP-HP), Paris, FR;(3) Service de Rhumathologie A, Ho^pital Cochin (AP-HP), Paris, FR;(4) CMD Forcilles, 77 Ferolles-Attilly, France, FR |
| |
Abstract: | We measured bone mineral density (BMD), four markers of bone formation bone alkaline phosphatase (bAP), osteocalcin (Oc),
N- and C-terminal propeptide of type I procollagen (PINP and PICP respectively)] and five markers of bone resorption serum
C-terminal telopeptide of type I collagen (CTx), urinary CTx, N-terminal cross-linked telopeptide (NTx), free and total deoxypyridinoline
(fDpd and tDpd respectively)] in 28 healthy premenopausal women (45.7 ± 3.0 years), 15 early (<7 years) healthy menopausal
women (53.8 ± 3.1 years) and 20 osteoporotic women (65.3 ± 8.2 years). Bone markers and BMD were also measured in the osteoporotic
women 4.1 ± 0.2 and 12.6 ± 1.2 months after the beginning of alendronate therapy (Fosamax, 10 mg/day) respectively (BMD in
16/20). We calculated the intra-individual coefficient of variation (iCV) and the least significant change (LSC) for each
bone marker from a subset of 9 healthy premenopausal women (32 ± 5 years) who had a first and a second morning void urine
collection (FMV and SMV respectively) and a blood sample on 4 nonconsecutive days (mean interval 14 ± 3 days). None of the
bone markers was correlated with BMD (except p= 0.043 between serum Oc and hip BMD). All markers, except fDpd, were increased significantly in early menopausal women when
compared with the premenopausal group. Serum CTx presented the highest increase at menopause (+67.8%) and identified the highest
rate (11/15) of early menopausal women with bone turnover above the premenopausal range. The iCVs for bone formation markers
(7.2–14.4%) were lower than those for bone resorption markers (14.6–22.3%). The iCVs obtained on FMV and SMV were not different.
The decrease after 4 months of alendronate was significant for each bone marker but variable from one marker to another. Serum
CTx showed the largest decrease (70.8%) and identified the highest number of biologically responding patients (change >LSC;
n= 17/20). A significant change in serum CTx after 4 months of alendronate was the best predictor of a significant gain in
spine BMD (i.e., ≥27 mg/cm2) after 1 year of therapy, allowing 15 of 16 patients (94%) to be classified correctly (one false-positive). Urinary NTx/Cr
was the second best predictor. Despite a moderately high iCV (20.6%), serum CTx appeared the most effective of the markers
tested and could be of interest for the detection of high bone turnover and the longitudinal monitoring of alendronate therapy
in the individual patient. It must be stressed that serum PINP and urinary NTx and tDpd compared very similarly with serum
CTx for monitoring alendronate therapy.
Received: 12 April 1999 / Accepted: 13 September 1999 |
| |
Keywords: | :Alendronate – Biochemical markers – Bone turnover – Osteoporosis – Within-subject variability |
本文献已被 SpringerLink 等数据库收录! |
|