Response of bone turnover markers to three oral bisphosphonate therapies in postmenopausal osteoporosis: the TRIO study View Full Text


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Article Info

DATE

2015-05-20

AUTHORS

K. E. Naylor, R. M. Jacques, M. Paggiosi, F. Gossiel, N. F. A. Peel, E. V. McCloskey, J. S. Walsh, R. Eastell

ABSTRACT

We used bone turnover markers to identify women who responded to bisphosphonate treatment for osteoporosis. Response was more likely with alendronate and ibandronate than risedronate. There was a greater decrease in bone markers if baseline bone turnover markers were higher and if the patient took more than 80 % of her medication.IntroductionBiochemical response to bisphosphonate therapy can be assessed using either a decrease in bone turnover marker beyond the least significant change (LSC) or a reduction to within a reference interval (RI). We compared the performance of these target responses and determined whether response was related to the type of bisphosphonate, compliance and baseline bone turnover markers.MethodsBiochemical responses to three oral bisphosphonates were assessed in an open, controlled trial comprising 172 postmenopausal osteoporotic women (age 53–84 years), randomised to alendronate, ibandronate or risedronate, plus calcium and vitamin D supplementation for 2 years. The LSC for each marker was derived within the study population, whereas RIs were obtained from a control group of healthy premenopausal women (age 35–40 years).ResultsOver 70 % of women achieved a target response for serum CTX and PINP, irrespective of the approach used. The percentage decrease at 12 weeks was greater for women with baseline PINP above the RI −63 % (difference 13 %, 95 % CI 0 to 27.1, P = 0.049) and good compliance −67 % (difference 15.9 %, 95 % CI 6.3 to 25.5, P = 0.001). Responders had a greater increase in spine bone density compared to nonresponders; for example 6.2 vs. 2.3 % (difference 3.9 %, 95 % CI 1.6 to 6.3, P = 0.0011) for PINP LSC. The magnitude of change in bone markers was greater with ibandronate and alendronate than risedronate.ConclusionsBoth approaches to response identified similar proportions of women as responders. Nonresponders had smaller increases in BMD, and we suggest that biochemical assessment of response is a useful tool for the management of women with postmenopausal osteoporosis. More... »

PAGES

21-31

References to SciGraph publications

  • 2000-12. Preanalytical Variability of Biochemical Markers of Bone Turnover in OSTEOPOROSIS INTERNATIONAL
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  • 2004-05-27. The impact of compliance with osteoporosis therapy on fracture rates in actual practice in OSTEOPOROSIS INTERNATIONAL
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    http://scigraph.springernature.com/pub.10.1007/s00198-015-3145-7

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    http://dx.doi.org/10.1007/s00198-015-3145-7

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    https://app.dimensions.ai/details/publication/pub.1038798784

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/25990354


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    39 schema:description We used bone turnover markers to identify women who responded to bisphosphonate treatment for osteoporosis. Response was more likely with alendronate and ibandronate than risedronate. There was a greater decrease in bone markers if baseline bone turnover markers were higher and if the patient took more than 80 % of her medication.IntroductionBiochemical response to bisphosphonate therapy can be assessed using either a decrease in bone turnover marker beyond the least significant change (LSC) or a reduction to within a reference interval (RI). We compared the performance of these target responses and determined whether response was related to the type of bisphosphonate, compliance and baseline bone turnover markers.MethodsBiochemical responses to three oral bisphosphonates were assessed in an open, controlled trial comprising 172 postmenopausal osteoporotic women (age 53–84 years), randomised to alendronate, ibandronate or risedronate, plus calcium and vitamin D supplementation for 2 years. The LSC for each marker was derived within the study population, whereas RIs were obtained from a control group of healthy premenopausal women (age 35–40 years).ResultsOver 70 % of women achieved a target response for serum CTX and PINP, irrespective of the approach used. The percentage decrease at 12 weeks was greater for women with baseline PINP above the RI −63 % (difference 13 %, 95 % CI 0 to 27.1, P = 0.049) and good compliance −67 % (difference 15.9 %, 95 % CI 6.3 to 25.5, P = 0.001). Responders had a greater increase in spine bone density compared to nonresponders; for example 6.2 vs. 2.3 % (difference 3.9 %, 95 % CI 1.6 to 6.3, P = 0.0011) for PINP LSC. The magnitude of change in bone markers was greater with ibandronate and alendronate than risedronate.ConclusionsBoth approaches to response identified similar proportions of women as responders. Nonresponders had smaller increases in BMD, and we suggest that biochemical assessment of response is a useful tool for the management of women with postmenopausal osteoporosis.
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    46 CTX
    47 ConclusionsBoth
    48 D supplementation
    49 PINP
    50 ResultsOver 70
    51 alendronate
    52 approach
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    54 baseline bone turnover markers
    55 biochemical assessment
    56 bisphosphonate therapy
    57 bisphosphonates
    58 bone density
    59 bone markers
    60 bone turnover markers
    61 calcium
    62 changes
    63 compliance
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    65 decrease
    66 density
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    68 greater decrease
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    72 increase
    73 interval
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    75 magnitude
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    77 management
    78 management of women
    79 markers
    80 medications
    81 nonresponders
    82 oral bisphosphonate therapy
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    84 osteoporosis
    85 osteoporotic women
    86 patients
    87 percentage decrease
    88 performance
    89 population
    90 postmenopausal osteoporosis
    91 postmenopausal osteoporotic women
    92 premenopausal women
    93 proportion
    94 reduction
    95 reference intervals
    96 responders
    97 response
    98 risedronate
    99 serum CTX
    100 significant changes
    101 similar proportions
    102 small increase
    103 spine bone density
    104 study
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    106 supplementation
    107 target response
    108 therapy
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    111 trials
    112 trio studies
    113 turnover markers
    114 type of bisphosphonate
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    117 vitamin D supplementation
    118 weeks
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