Levels of C-telopeptide fragments of collagen type I enable the monitoring and early adjustment of clodronate therapy in patients with postmenopausal osteoporosis.

We monitored the efficacy of therapy with clodronate, a bisphosphonate drug, in women with postmenopausal osteoporosis, using urinary immunoenzymatic assay of C-telopeptide of collagen type I, an eight amino acid fragment (collagen fragment) of the C-telopeptide of the alpha1-chain of collagen type I (EKAHDGGR). The analysis of the dynamics of collagen fragment concentrations (a marker of bone resorption) during treatment suggests the possibility of early modulation and customization of therapy based on the levels of this marker. This could enable improved control over secondary effects and side effects of clodronate therapy. Pharmacologic inhibition of bone resorption by osteoclasts could be indirectly responsible for the increase in parathyroid hormone found during treatment with clodronate. Increased levels of parathyroid hormone are probably necessary to stimulate residual osteoclast activity and are sufficient for the maintenance of calcium-phosphate homeostasis in a new pharmacologically-induced equilibrium. Outside this context the levels of parathyroid hormone of certain patients would be considered pathologic.