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Early Changes in Serum N-Telopeptide and C-Telopeptide Cross-Linked Collagen Type 1 Predict Long-Term Response to Alendronate Therapy in Elderly Women¹

Divisions of Endocrinology and Metabolism and Geriatrics, Department of Medicine, University of Pittsburgh Medical Center (S.L.G.), Pittsburgh, Pennsylvania 15213; and Charles A. Dana Research Institute, Harvard-Thorndike General Clinical Research Center (S.L.G., H.N.R., R.A.P.); Divisions of Bone and Mineral Metabolism and Gerontology, Department of Medicine (H.N.R.); and Biometrics Center (R.A.P.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts 02215

Address all correspondence and requests for reprints to: Susan L. Greenspan, M.D., University of Pittsburgh Medical Center, Osteoporosis Prevention and Treatment Center, 1110 Kaufmann Building, 3471 Fifth Avenue, Pittsburgh, Pennsylvania 15213. E-mail: greenspans{at}msx

The aim of this study was to determine whether early changes in serum markers of bone resorption could predict long-term responses in bone mineral density (BMD) after alendronate therapy in elderly women. One hundred and twenty women (mean age, 70 yr) were randomized to alendronate or placebo in this double blind, placebo-controlled clinical trial for 2.5 yr. Outcome measures were hip and spine BMD and biochemical markers of bone resorption, including serum N-telopeptide and C-telopeptide cross-linked collagen type I (NTx and CTx, respectively). Serum NTx and CTx were highly correlated at baseline (r = 0.73; P < 0.001) and remained so throughout the study (range, r = 0.36–0.56; all P < 0.05). After treatment with alendronate, serum NTx decreased 30.4 ± 16.0% at 6 months, reaching a nadir of -36.7 ± 18.0% by 24 months (P < 0.001). Serum CTx decreased 43.5 ± 67.0% at 6 months and continued to decrease to 67.3 ± 19.3% at 2.5 yr (P < 0.001). Moreover, decreases in serum NTx and CTx at 6 months were correlated with long-term improvements in vertebral BMD at 2.5 yr in patients receiving alendronate therapy (NTx: r = -0.42; CTx: r = -0.31; both P < 0.05). We conclude that early changes in serum NTx and CTx, markers of bone resorption, predict long-term changes in vertebral BMD in elderly women receiving alendronate therapy and provide a useful tool to assess skeletal health.

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