Biochemical markers of bone turnover to monitor the bone response to postmenopausal hormone replacement therapy

Abstract

Hormone replacement therapy (HRT) prevents postmenopausal bone loss, and is therefore increasingly prescribed to prevent the development of postmenopausal osteoporosis. Because of individual differences in the response to HRT as well as problems with compliance, it has been debated how the skeletal response to HRT should be monitored. When estrogen production decreases at the menopause, a number of biochemical markers of bone turnover increase considerably in the order of 50%-100% from baseline. When HRT is instituted, the markers decrease again within the following 3-6 months. In the present prospective study we investigated whether the determination of biochemical markers of bone turnover may be useful for monitoring the skeletal effect of HRT. Seventy-six early postmenopausal women received HRT and 43 received placebo. The treatment period was 24 months and the women were followed with repeated bone mass measurements (every 3 months) which allowed calculation of the bone loss. Serum and urine samples were collected at 3, 6, 12 and 24 months. The placebo group lost a significant amount of bone mineral density in both the forearm and the spine (p < 0.001), whereas the HRT group did not. There was, however, a relatively large overlap of values between the HRT and placebo groups, especially in the spine. After 3 months' treatment the correlation between the changes in the markers and the bone loss was r = 0.59, and this value increased to r = 0.66 at 6 months and r = 0.76 and r = 0.77 at 12 and 24 months, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

The course of bone mineral density and biochemical markers of bone turnover in early postmenopausal spinal cord-lesioned females

“…21 In normal early postmenopausal females, the change in biochemical markers of bone turnover correlates well with the changes in BMD in spine and forearm, and increases 50-100% from baseline values. 22 Also in the present study, bone turnover increased in the years after the menopause. The increase reached significance for variables of bone formation, but not for variables of bone resorption.…”

Bone Resorption in Post-menopausal Women with Normal and Low BMD Assessed with Biochemical Markers Specific for Telopeptide Derived Degradation Products of Collagen Type I

“…These markers have been extensively used for both the assessment of therapeutic efficacy of antiresorptive drugs in osteoporosis and for prediction of fracture risk in postmenopausal women [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. We measured urinary and serum CTx and urinary NTx in a large cohort of untreated, healthy women stratified on the basis of their menopausal status and BMD.…”

“…Furthermore, biochemical markers of bone remodeling are a valuable supplement to bone mineral density measurement (BMD), as they provide a dynamic measure of the current bone turnover state compared with the static measure of skeletal status provided by BMD. Thus, biochemical markers of bone turnover provide a rapid assessment of the effects of antiresorptive therapies such as hormone replacement therapy, bisphosphonates, and calcitonin which induce a decrease in the levels of bone markers that is correlated with the long-term effect of such treatments on bone mass [5][6][7][8][9][10][11][12][13][14][15]. Due to the small annual changes in BMD, the effect of antiresorptive therapy can only be reliably monitored by BMD measurement after several years followup [5,10,13].…”

Early Changes in Biochemical Markers of Bone Turnover Predict Bone Mineral Density Response to Antiresorptive Therapy in Korean Postmenopausal Women with Osteoporosis

“…Moreover, some markers of bone resorption predict the subsequent risk of hip fracture independently of bone mineral density (BMD) [4,5], which is still the single most important predictor for osteoporotic fracture [6][7][8]. Recently, it has been also suggested that the biochemical markers of bone turnover may be used to monitor the efficacy of antiresorptive therapy in patients with osteoporosis [9][10][11][12][13].Patients with high turnover at baseline have a significantly higher increase in spinal BMD in response to injectable or nasal calcitonin than those with low turnover [14]. A similar trend has been observed in patients treated with hormone thearpy (HT) or alen-…”

“…Moreover, in addition to the baseline values, the decrease in bone turnover markers after antiresorptive therapy is strongly correlated to the increase in BMD. Antiresorptive therapy induces a 30%-60% decrease in markers of resorption and formation that fall within the premenopausal range within only 3-6 months [9][10][11][12][13]. In contrast, given the 1-2% precision error of bone mass measurement by dualenergy X-ray absorptiometry (DXA) and the expected change in bone mass induced by antiresorptive treatment, it is usually necessary to wait up to 1-2 years after initiating therapy to determine whether treatment is effective.…”