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Archives of Osteoporosis

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01-12-2020 | Osteoporosis | Original Article

Early changes in bone turnover predict longer-term changes in bone mineral density but not trabecular bone score in frail older women

Authors: Mary P. Kotlarczyk, Subashan Perera, Neil M. Resnick, David A. Nace, Susan L. Greenspan

Published in: Archives of Osteoporosis | Issue 1/2020

Abstract

Summary

Clinicians and patients want to know if therapy is working early in their course of treatment. We found that early changes in bone turnover markers at 6 months were associated with long-term changes in bone mineral density but not trabecular bone score at 12 and 24 months.

Purpose

We sought to examine the association between shorter-term changes in markers of bone turnover and longer-term changes in bone mineral density (BMD) and microstructure in a cohort of frail elderly women with multiple comorbid conditions including osteoporosis.

Methods

We performed a secondary analysis of a 2-year zoledronic acid trial for osteoporosis in 155 women residents of long-term care communities (mean age 86.9 years). We examined the association of the 6-month change in serum C-terminal crosslinking telopeptide of type I collagen (CTX) and serum intact procollagen type I N propeptide (PINP) with the 12- and 24-month changes in BMD at the spine and hip and the trabecular bone score (TBS), an indirect measure of bone microstructure.

Results

For every 0.2-ng/ml 6-month CTX decrease, the corresponding increase in spine BMD at 12 and 24 months was 0.2% (p = 0.7210) and 1.1% (p = 0.0396), respectively; total hip BMD 1.1% (p = 0.0279) and 0.9% (p = 0.0716); and femoral neck BMD 1.7% (p = 0.0079) and 0.9% (p = 0.1698). Similarly, for every 20-ng/ml 6-month PINP decrease, the corresponding increase in spine BMD at 12 and 24 months was 0.9% (p = 0.0286) and 1.4% (p = 0.0012), respectively; total hip BMD 1.4% (p = 0.0005) and 1.4% (p = 0.0006); and femoral neck BMD 2.3% (p < 0.0001) and 2.0% (p < 0.0001). Bone marker changes were not consistently associated with TBS changes.

Conclusion

Shorter-term 6-month changes in bone turnover markers are associated with the long-term changes in BMD over 1–2 years in the spine and hip but not with TBS.

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Cosman F, de Beur SJ, LeBoff MS, Lewiecki EM, Tanner B, Randall S, Lindsay R, National Osteoporosis F (2014) Clinician's guide to prevention and treatment of osteoporosis. Osteoporos Int 25(10):2359–2381. https://doi.org/10.1007/s00198-014-2794-2CrossRefPubMedPubMedCentral

Bonnick SL, Shulman L (2006) Monitoring osteoporosis therapy: bone mineral density, bone turnover markers, or both? Am J Med 119(4 Suppl 1):S25–S31. https://doi.org/10.1016/j.amjmed.2005.12.020CrossRefPubMed

Bauer DC (2019) Clinical use of bone turnover markers. JAMA. 322:569. https://doi.org/10.1001/jama.2019.9372CrossRefPubMed

Bauer DC, Garnero P, Bilezikian JP, Greenspan SL, Ensrud KE, Rosen CJ, Palermo L, Black DM (2006) Short-term changes in bone turnover markers and bone mineral density response to parathyroid hormone in postmenopausal women with osteoporosis. J Clin Endocrinol Metab 91(4):1370–1375. https://doi.org/10.1210/jc.2005-1712CrossRefPubMed

Greenspan SL, Resnick NM, Parker RA (2005) Early changes in biochemical markers of bone turnover are associated with long-term changes in bone mineral density in elderly women on alendronate, hormone replacement therapy, or combination therapy: a three-year, double-blind, placebo-controlled, randomized clinical trial. J Clin Endocrinol Metab 90(5):2762–2767. https://doi.org/10.1210/jc.2004-1091CrossRefPubMed

Niimi R, Kono T, Nishihara A, Hasegawa M, Matsumine A, Nakamura T, Kono T, Sudo A (2014) An algorithm using the early changes in PINP to predict the future BMD response for patients treated with daily teriparatide. Osteoporos Int 25(1):377–384. https://doi.org/10.1007/s00198-013-2426-2CrossRefPubMed

Burnett-Bowie SM, Saag K, Sebba A, de Papp AE, Chen E, Rosenberg E, Greenspan SL (2009) Prediction of changes in bone mineral density in postmenopausal women treated with once-weekly bisphosphonates. J Clin Endocrinol Metab 94(4):1097–1103. https://doi.org/10.1210/jc.2008-1122CrossRefPubMedPubMedCentral

Bauer DC, Black DM, Garnero P, Hochberg M, Ott S, Orloff J, Thompson DE, Ewing SK, Delmas PD, Fracture Intervention Trial Study G (2004) Change in bone turnover and hip, non-spine, and vertebral fracture in alendronate-treated women: the fracture intervention trial. J Bone Miner Res 19(8):1250–1258. https://doi.org/10.1359/JBMR.040512CrossRefPubMed

Eastell R, Barton I, Hannon RA, Chines A, Garnero P, Delmas PD (2003) Relationship of early changes in bone resorption to the reduction in fracture risk with risedronate. J Bone Miner Res 18(6):1051–1056. https://doi.org/10.1359/jbmr.2003.18.6.1051CrossRefPubMed

10.

Hochberg MC, Greenspan S, Wasnich RD, Miller P, Thompson DE, Ross PD (2002) Changes in bone density and turnover explain the reductions in incidence of nonvertebral fractures that occur during treatment with antiresorptive agents. J Clin Endocrinol Metab 87(4):1586–1592. https://doi.org/10.1210/jcem.87.4.8415CrossRefPubMed

11.

Jacques RM, Boonen S, Cosman F, Reid IR, Bauer DC, Black DM, Eastell R (2012) Relationship of changes in total hip bone mineral density to vertebral and nonvertebral fracture risk in women with postmenopausal osteoporosis treated with once-yearly zoledronic acid 5 mg: the HORIZON-Pivotal Fracture Trial (PFT). J Bone Miner Res 27(8):1627–1634. https://doi.org/10.1002/jbmr.1644CrossRefPubMed

12.

Aleksova J, Kurniawan S, Elder GJ (2018) The trabecular bone score is associated with bone mineral density, markers of bone turnover and prevalent fracture in patients with end stage kidney disease. Osteoporos Int 29(6):1447–1455. https://doi.org/10.1007/s00198-018-4468-yCrossRefPubMed

13.

Greenspan SL, Perera S, Ferchak MA, Nace DA, Resnick NM (2015) Efficacy and safety of single-dose zoledronic acid for osteoporosis in frail elderly women: a randomized clinical trial. JAMA Intern Med 175(6):913–921. https://doi.org/10.1001/jamainternmed.2015.0747CrossRefPubMedPubMedCentral

14.

Varney LF, Parker RA, Vincelette A, Greenspan SL (1999) Classification of osteoporosis and osteopenia in postmenopausal women is dependent on site-specific analysis. J Clin Densitom 2(3):275–283. https://doi.org/10.1385/jcd:2:3:275CrossRefPubMed

15.

Binkley N, Leslie WD (2016) Clinical application of spine trabecular bone score (TBS). Clinical Reviews in Bone and Mineral Metabolism 14(1):14–25. https://doi.org/10.1007/s12018-016-9203-7CrossRef

16.

Shevroja E, Lamy O, Kohlmeier L, Koromani F, Rivadeneira F, Hans D (2017) Use of trabecular bone score (TBS) as a complementary approach to dual-energy X-ray absorptiometry (DXA) for fracture risk assessment in clinical practice. J Clin Densitom 20(3):334–345. https://doi.org/10.1016/j.jocd.2017.06.019CrossRefPubMed

17.

Hans D, Barthe N, Boutroy S, Pothuaud L, Winzenrieth R, Krieg MA (2011) Correlations between trabecular bone score, measured using anteroposterior dual-energy X-ray absorptiometry acquisition, and 3-dimensional parameters of bone microarchitecture: an experimental study on human cadaver vertebrae. J Clin Densitom 14(3):302–312. https://doi.org/10.1016/j.jocd.2011.05.005CrossRefPubMed

18.

Winzenrieth R, Michelet F, Hans D (2013) Three-dimensional (3D) microarchitecture correlations with 2D projection image gray-level variations assessed by trabecular bone score using high-resolution computed tomographic acquisitions: effects of resolution and noise. J Clin Densitom 16(3):287–296. https://doi.org/10.1016/j.jocd.2012.05.001CrossRefPubMed

19.

Kanis JA (2002) Diagnosis of osteoporosis and assessment of fracture risk. Lancet 359(9321):1929–1936. https://doi.org/10.1016/S0140-6736(02)08761-5CrossRefPubMed

20.

Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW (1963) Studies of illness in the aged. The Index of Adl: A Standardized Measure of Biological and Psychosocial Function. JAMA 185:914–919CrossRefPubMed

21.

Lawton MP, Brody EM (1969) Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 9(3):179–186CrossRefPubMed

22.

Abellan van Kan G, Rolland Y, Houles M, Gillette-Guyonnet S, Soto M, Vellas B (2010) The assessment of frailty in older adults. Clin Geriatr Med 26(2):275–286. https://doi.org/10.1016/j.cger.2010.02.002CrossRefPubMed

23.

Studenski S, Perera S, Patel K, Rosano C, Faulkner K, Inzitari M, Brach J, Chandler J, Cawthon P, Connor EB, Nevitt M, Visser M, Kritchevsky S, Badinelli S, Harris T, Newman AB, Cauley J, Ferrucci L, Guralnik J (2011) Gait speed and survival in older adults. JAMA 305(1):50–58. https://doi.org/10.1001/jama.2010.1923CrossRefPubMedPubMedCentral

24.

Pfeiffer E (1975) A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. J Am Geriatr Soc 23(10):433–441CrossRefPubMed

25.

Rigler SK, Studenski S, Wallace D, Reker DM, Duncan PW (2002) Co-morbidity adjustment for functional outcomes in community-dwelling older adults. Clin Rehabil 16(4):420–428CrossRefPubMed

26.

Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, MA MB, Cardiovascular Health Study Collaborative Research G (2001) Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 56(3):M146–M156CrossRefPubMed

27.

Binder EF, Miller JP, Ball LJ (2001) Development of a test of physical performance for the nursing home setting. Gerontologist 41(5):671–679CrossRefPubMed

28.

Gossiel F, Paggiosi MA, Naylor KE, McCloskey EV, Walsh J, Peel N, Eastell R (2019) The effect of bisphosphosphonates on bone turnover and bone balance in postmenopausal women with osteoporosis: the T-score bone marker approach in the TRIO study. Bone 131:115158. https://doi.org/10.1016/j.bone.2019.115158CrossRefPubMed

29.

Greenspan SL, Parker RA, Ferguson L, Rosen HN, Maitland-Ramsey L, Karpf DB (1998) Early changes in biochemical markers of bone turnover predict the long-term response to alendronate therapy in representative elderly women: a randomized clinical trial. J Bone Miner Res 13(9):1431–1438. https://doi.org/10.1359/jbmr.1998.13.9.1431CrossRefPubMed

30.

Garnero P, Hausherr E, Chapuy MC, Marcelli C, Grandjean H, Muller C, Cormier C, Breart G, Meunier PJ, Delmas PD (1996) Markers of bone resorption predict hip fracture in elderly women: the EPIDOS Prospective Study. J Bone Miner Res 11(10):1531–1538. https://doi.org/10.1002/jbmr.5650111021CrossRefPubMed

31.

Bell KJ, Hayen A, Glasziou P, Irwig L, Eastell R, Harrison SL, Black DM, Bauer DC (2016) Potential usefulness of BMD and bone turnover monitoring of zoledronic acid therapy among women with osteoporosis: secondary analysis of randomized controlled trial data. J Bone Miner Res 31(9):1767–1773. https://doi.org/10.1002/jbmr.2847CrossRefPubMed

32.

Tsai JN, Burnett-Bowie SM, Lee H, Leder BZ (2017) Relationship between bone turnover and density with teriparatide, denosumab or both in women in the DATA study. Bone 95:20–25. https://doi.org/10.1016/j.bone.2016.11.009CrossRefPubMed

33.

Eastell R, Mitlak BH, Wang Y, Hu M, Fitzpatrick LA, Black DM (2019) Bone turnover markers to explain changes in lumbar spine BMD with abaloparatide and teriparatide: results from ACTIVE. Osteoporos Int 30(3):667–673. https://doi.org/10.1007/s00198-018-04819-1CrossRefPubMedPubMedCentral

34.

Lane NE, Sanchez S, Genant HK, Jenkins DK, Arnaud CD (2000) Short-term increases in bone turnover markers predict parathyroid hormone-induced spinal bone mineral density gains in postmenopausal women with glucocorticoid-induced osteoporosis. Osteoporos Int 11(5):434–442. https://doi.org/10.1007/s001980070111CrossRefPubMed

35.

Krieg MA, Aubry-Rozier B, Hans D, Leslie WD, Manitoba Bone Density P (2013) Effects of anti-resorptive agents on trabecular bone score (TBS) in older women. Osteoporos Int 24(3):1073–1078. https://doi.org/10.1007/s00198-012-2155-yCrossRefPubMed

36.

Marques IDB, Araujo M, Graciolli FG, Dos Reis LM, Pereira RMR, Alvarenga JC, Custodio MR, Jorgetti V, Elias RM, Moyses RMA, David-Neto E (2019) A randomized trial of zoledronic acid to prevent bone loss in the first year after kidney transplantation. J Am Soc Nephrol 30(2):355–365. https://doi.org/10.1681/ASN.2018060656CrossRefPubMedPubMedCentral

37.

Recker RR, Delmas PD, Halse J, Reid IR, Boonen S, Garcia-Hernandez PA, Supronik J, Lewiecki EM, Ochoa L, Miller P, Hu H, Mesenbrink P, Hartl F, Gasser J, Eriksen EF (2008) Effects of intravenous zoledronic acid once yearly on bone remodeling and bone structure. J Bone Miner Res 23(1):6–16. https://doi.org/10.1359/jbmr.070906CrossRefPubMed

38.

Clowes JA, Hannon RA, Yap TS, Hoyle NR, Blumsohn A, Eastell R (2002) Effect of feeding on bone turnover markers and its impact on biological variability of measurements. Bone 30(6):886–890. https://doi.org/10.1016/s8756-3282(02)00728-7CrossRefPubMed

Title: Early changes in bone turnover predict longer-term changes in bone mineral density but not trabecular bone score in frail older women
Authors: Mary P. Kotlarczyk
Subashan Perera
Neil M. Resnick
David A. Nace
Susan L. Greenspan
Publication date: 01-12-2020
Publisher: Springer London
Keywords: Osteoporosis
Osteoporosis
Zoledronic Acid
Published in: Archives of Osteoporosis / Issue 1/2020
Print ISSN: 1862-3522
Electronic ISSN: 1862-3514
DOI: https://doi.org/10.1007/s11657-020-00749-w

2024 ASCO Annual Meeting

Springer Medicine

Early changes in bone turnover predict longer-term changes in bone mineral density but not trabecular bone score in frail older women

Abstract

Summary

Purpose

Methods

Results

Conclusion

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Summary

Purpose

Methods

Results

Conclusion

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