Short-term changes in bone turnover markers and bone mineral density response to parathyroid hormone in postmenopausal women with osteoporosis
Short-term changes in bone turnover markers and bone mineral density response to parathyroid hormone in postmenopausal women with osteoporosis
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DOI：
10.1210/jc.2005-1712
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发表时间：
2006-04-01
影响因子：
5.8
通讯作者：
Black, DM
中科院分区：
文献类型：
--
作者：
Bauer, DC;Garnero, P;Black, DM
背景：骨质疏松女性接受 PTH 治疗可增加骨转换的生化标志物，增加轴向骨矿物质密度 (BMD)，并降低骨折风险。目的：我们的目的是确定 PTH 治疗前基线转换水平与 PTH 治疗期间转换的短期变化以及随后面积和体积 BMD 变化之间的关系。设计和设置：我们在四个学术中心进行了一项随机、安慰剂对照试验。患者：患者包括 238 名患有低髋关节或低位髋关节的绝经后女性。干预：受试者被随机分配接受皮下 PTH（1 - 84）、100 微克/天（119 名女性），为期 1 年。主要结果测量：在治疗前以及治疗 1 个月和 3 个月后收集的空腹血样中测量骨转换标志物。治疗 1 年后，通过双能 X 射线骨密度测定法和定量计算机断层扫描 (QCT) 评估脊柱和髋部的面积和体积 BMD。 结果：在仅接受 PTH 治疗的女性中，基线周转率与双能 X 射线骨密度测定法和 QCT BMD 的 1 年变化之间的关系不一致。 1 个月和 3 个月的周转率（尤其是 I 型胶原蛋白的形成标记 N 前肽）的较大增加与面积 BMD 的较大增加相关。当通过 QCT 评估髋部和脊柱体积 BMD 时，周转率的短期增加与 BMD 的 1 年增加呈更正相关。 I 型胶原蛋白 N 前肽 3 个月变化的每一个 SD 增加都与 QCT 脊柱小梁 BMD 增加 21% 相关。结论：PTH 治疗的短期周转变化越大，绝经后骨质疏松女性的脊柱和髋部 BMD 1 年增加幅度越大。
Context: Treatment of osteoporotic women with PTH increases biochemical markers of bone turnover, increases axial bone mineral density (BMD), and reduces fracture risk.Objective: Our objective was to determine the relationship between levels of baseline turnover before PTH therapy and short-term changes in turnover during PTH therapy and subsequent changes in areal and volumetric BMD.Design and Setting: We conducted a randomized, placebo-controlled trial at four academic centers.Patients: Patients included 238 postmenopausal women with low hip or spine BMD.Intervention: Subjects were randomized to sc PTH ( 1 - 84), 100 mu g/d ( 119 women), for 1 yr.Main Outcome Measure: Bone turnover markers were measured in fasting blood samples collected before therapy and after 1 and 3 months. Areal and volumetric BMD at the spine and hip were assessed by dual-energy x-ray absorptiometry and quantitative computed tomography (QCT) after 1 yr of therapy.Results: Among women treated with PTH alone, the relationships between baseline turnover and 1-yr changes in dual-energy x-ray absorptiometry and QCT BMD were inconsistent. Greater 1- and 3-month increases in turnover, particularly the formation marker N-propeptide of type I collagen, were associated with greater increases in areal BMD. When volumetric hip and spine BMD were assessed by QCT, greater short-term increases in turnover were even more positively associated with 1- yr increases in BMD. Each SD increase in the 3-month change of N-propeptide of type I collagen was associated with an a 21% greater increase in QCT spine trabecular BMD.Conclusions: Greater short-term changes in turnover with PTH therapy are associated with greater 1- yr increases in spine and hip BMD among postmenopausal osteoporotic women.