Effects of 25-Hydroxyvitamin D3 Therapy on Bone Turnover Markers and PTH Levels in Postmenopausal Osteoporotic Women Treated with Alendronate
Effects of 25-Hydroxyvitamin D3 Therapy on Bone Turnover Markers and PTH Levels in Postmenopausal Osteoporotic Women Treated with Alendronate
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DOI：
10.1210/jc.2012-2999
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发表时间：
2012-12-01
影响因子：
5.8
通讯作者：
Gonzalez-Macias, Jesus
中科院分区：
文献类型：
--
作者：
Olmos, Jose M.;Hernandez, Jose L.;Gonzalez-Macias, Jesus
目的：我们的目的是了解骨转换标志物的下降在多大程度上受到接受阿仑膦酸钠（ALN）治疗的患者血清25-羟基维生素D（25 OHD）水平的影响。设计、参与者和设置：共有140名绝经后骨质疏松妇女被随机分为两组，一组接受ALN治疗，另一组接受ALN +25 OHD（3）（ALN+VitD）治疗，为期3个月。结果：ALN+VitD组25 OHD较治疗前升高4倍，ALN组无明显变化。给予ALN导致血清CTX（53 +/- 24%）和P1 NP（46 +/- 19%）显著下降。ALN+VitD后，CTX下降61 +/- 20%（与ALN相比P = 0.06），P1 NP下降50 +/- 23%（P = 0.35）。当患者分为基线血清25 OHD低于和高于20 ng/ml的患者时，在低于20 ng/ml的患者中，ALN组的CTX降低了48 +/- 26%，ALN+VitD组降低了61 +/- 17%（P = 0.015）。对于P1 NP，相应的数字为43 +/- 20和50 +/- 23%（P = 0.2）。在高于20 ng/ml的患者中，未观察到CTX的差异（ALN组降低58 +/- 21%，ALN+VitD组降低60 +/- 23%; P = 0.7）或P1 NP（49 +/- 18和50 +/- 20%; P = 0.9）。给予25 OHD（3）并不是双膦酸盐发挥骨抗吸收作用的必要条件。事实上，在维生素D充足的患者中，添加维生素时没有观察到任何益处。然而，在维生素D缺乏的患者中，观察到其给药后骨吸收标记物CTX的下降幅度约为25%。（临床内分泌代谢杂志97：4491-4497，2012）
Objective: Our objective was to know the extent to which a fall in bone turnover markers is influenced by serum 25-hydroxyvitamin D (25OHD) levels in patients on alendronate (ALN) treatment.Design, Participants, and Setting: A total of 140 postmenopausal osteoporotic women were randomized to receive either ALN or ALN plus 25OHD(3) (ALN+VitD) over a 3-month period. Serum 25OHD, PTH, C-terminal telopeptide of type I collagen (CTX), and amino-terminal propeptide of type I collagen (P1NP) were measured at baseline and at the end of the 3 months.Results: 25OHD rose four times above baseline levels in the ALN+VitD group, whereas no changes were seen in the ALN group. Administering ALN resulted in a significant decline in both serum CTX(53 +/- 24%) and P1NP(46 +/- 19%). After ALN+VitD, the fall in CTX amounted to 61 +/- 20%(P = 0.06 compared with ALN) and P1NP to 50 +/- 23% (P = 0.35). When patients were divided into those below and above 20 ng/ml of baseline serum 25OHD, in those below, CTX decreased by 48 +/- 26% in the ALN group and by 61 +/- 17% in the ALN+VitD group (P = 0.015). For P1NP, the corresponding figures were 43 +/- 20 and 50 +/- 23% (P = 0.2). In patients above 20 ng/ml, no differences were seen regarding CTX (58 +/- 21% decrease in the ALN group and 60 +/- 23% in the ALN+VitD group; P = 0.7) or P1NP (49 +/- 18 and 50 +/- 20%; P = 0.9).Conclusions: Administration of 25OHD(3) is not an indispensable requirement for bisphosphonates to develop their bone antiresorptive effect. In fact, in patients with vitamin D sufficiency, no benefit is observed when the vitamin is added. However, in patients with vitamin D deficiency, an approximately 25% greater fall in the bone resorption marker CTX is seen with its administration. (J Clin Endocrinol Metab 97: 4491-4497, 2012)