Markers of bone turnover for the prediction of fracture risk and monitoring of osteoporosis treatment: a need for international reference standards

Vasikaran, Samuel; Eastell, Richard; Bruyère, Olivier; Foldes, A. Joseph; Garnero, Patrick; Griesmacher, Andrea; McClung, Michael R.; Morris, Howard A.; Silverman, Stuart L.; Trenti, Tommaso; Wahl, D. A.; Cooper, Cyrus; Kanis, John А.

doi:10.1007/s00198-010-1501-1

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“…The LSC was less for the raloxifene study -45% CTX and -27% PINP in comparison to the TRIO study (-56% CTX, -38% PINP). There are several ways that LSC can be calculated [10,29] .…”

Section: Discussionmentioning

confidence: 99%

“…In clinical trials, the changes in bone turnover markers have been shown to be related to change in fracture risk [10] . There is evidence that there is an association between the change in bone formation markers but not bone resorption markers on raloxifene and the reduction in spine fracture risk [5,[11][12][13] .…”

Section: Introductionmentioning

confidence: 99%

“…Studies have reported poor reproducibility of bone markers between laboratories [18,19] . The standardization of bone marker measurements is currently being addressed with the introduction of international reference standards [10] . It has been proposed that the C terminal telopeptide of type I collagen (CTX) and N terminal propeptide of type I procollagen (PINP) are adopted as reference bone markers.…”

Section: Introductionmentioning

confidence: 99%

“…There are two methods that have been proposed when using bone markers to assess response to osteoporosis treatment [10] . Firstly the least significant change (LSC) approach which is the minimum change in bone markers that can be attributed to the treatment effect rather than random variation in the marker, or secondly a reduction in bone markers to below the mean of the reference interval (RI) for premenopausal women [10,12] .…”

Section: Introductionmentioning

confidence: 99%

“…Firstly the least significant change (LSC) approach which is the minimum change in bone markers that can be attributed to the treatment effect rather than random variation in the marker, or secondly a reduction in bone markers to below the mean of the reference interval (RI) for premenopausal women [10,12] . Both of these approaches can be useful to monitor the response to bisphosphonate treatment using bone markers [20] , however the use of BTM for monitoring less potent treatment may not be as informative.…”

Section: Introductionmentioning

confidence: 99%

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Response of bone turnover markers to raloxifene treatment in postmenopausal women with osteopenia

et al. 2016

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Introduction: The change in bone turnover markers (BTM) in response to osteoporosis therapy can be assessed by a decrease beyond the least significant change (LSC) or below the mean of the reference interval (RI). We compared the performance of these two approaches in women treated with raloxifene.Methods: Fifty postmenopausal osteopenic women, (age 51-72y) were randomised to raloxifene or no treatment for 2 years. Blood samples were collected for the measurement of BTM. The LSC for each marker was calculated from the untreated women and the RI obtained from healthy premenopausal women (age 35-40y). Bone mineral density (BMD) was measured at the spine and hip.Results: There was a decrease in BTM in response to raloxifene treatment; percentage change at 12 weeks, CTX -39% (95% CI -48 to -28) and PINP -32% (95% CI -40 to -23) P<0.001. The proportion of women classified as responding to treatment using LSC at 12 weeks was: CTX 38%, PINP 52%, at 48 weeks CTX 60%, PINP 65%. For the RI approach; at 12 weeks CTX and PINP 38%, at 48 weeks CTX 40%, PINP 45%. There was a significant difference in the change in spine BMD in the raloxifene treated group compared to the no-treatment group at week 48; difference 0.031 g/cm2, (95% CI 0.016 to 0.046, P<0.001).Conclusions: The two approaches identified women that reached the target for treatment using BTM.Both LSC and RI criteria appear useful in identifying treatment response but the two approaches do not fully overlap and may be complementary.

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“…The LSC was less for the raloxifene study -45% CTX and -27% PINP in comparison to the TRIO study (-56% CTX, -38% PINP). There are several ways that LSC can be calculated [10,29] .…”

Section: Discussionmentioning

confidence: 99%