Utility of biochemical markers of bone turnover in the follow-up of patients treated with bisphosphonates

被引:76
作者
Rosen, HN
Moses, AC
Garber, J
Ross, DS
Lee, SL
Greenspan, SL
机构
[1] Beth Israel Deaconess Med Ctr, Div Gerontol, Dept Med, Charles A Dana Res Inst, Boston, MA 02215 USA
[2] Beth Israel Deaconess Med Ctr, Div Gerontol, Dept Med, Harvard Thorndike Lab, Boston, MA 02215 USA
[3] Beth Israel Deaconess Med Ctr, Div Endocrinol, Dept Med, Harvard Thorndike Lab, Boston, MA 02215 USA
[4] Beth Israel Deaconess Med Ctr, Div Endocrinol, Dept Med, Charles A Dana Res Inst, Boston, MA 02215 USA
[5] Beth Israel Deaconess Med Ctr, Div Bone & Mineral Metab, Dept Med, Charles A Dana Res Inst, Boston, MA 02215 USA
[6] Beth Israel Deaconess Med Ctr, Div Bone & Mineral Metab, Dept Med, Harvard Thorndike Lab, Boston, MA 02215 USA
[7] Harvard Pilgrim Healthcare, Hlt Ctr Div, Endocrinol Sect, Boston, MA 02215 USA
[8] Massachusetts Gen Hosp, Dept Med, Thyroid Unit, Boston, MA 02215 USA
[9] New England Med Ctr, Dept Med, Endocrinol Diabet Metab & Mol Med Div, Boston, MA 02215 USA
关键词
bone turnover; bone resorption; N-telopeptide cross-links; deoxypyridinoline; bone-specific alkaline phosphatase;
D O I
10.1007/s002239900541
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Biochemical markers of bone turnover are often measured in patients treated with antiresorptive agents to monitor the effects of therapy. In order for a change in these markers to clearly indicate treatment effect, the change in the markers must exceed the amount of spontaneous variation typically seen with no treatment. Based on the measured long-term variability of markers in untreated patients, we defined a minimum significant change (MSC), that is, a change that was sufficiently large that it was unlikely to be due to spontaneous variability. We also examined the changes in markers of bone turnover in subjects treated with pamidronate to see how often observed changes in turnover after treatment exceeded the MSG. We found that urinary markers of bone resorption are best measured on 2-hour fasting samples, because results on random urine showed poor precision and less decline with therapy. We also found that of all the markers, urinary N-telopeptide cross-links (NTX) had the greatest decline after therapy (58%), although it also had the highest long-term variability (29.5%). The marker that most often showed a decline with treatment that exceeded the MSC was serum bone-specific alkaline phosphatase where 74% of observed changes exceeded the MSG. Other markers that often showed a decline with treatment that exceeded the MSC were 2-hour fasting urine NTX and free deoxypyridinoline, where 57% and 48%, respectively, of changes in therapy exceeded the MSG. The ideal marker would combine the large decline after treatment characteristic of NTX (60-70%) with the good precision of bone-specific alkaline phosphatase.
引用
收藏
页码:363 / 368
页数:6
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