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Short-Term Changes in Bone Turnover Markers and Bone Mineral Density Response to Parathyroid Hormone in Postmenopausal Women with Osteoporosis

Departments of Medicine (D.C.B.) and Epidemiology and Biostatistics (D.C.B., D.M.B., L.P.), University of California, San Francisco, San Francisco, California 94107; Synarc and Institut National de la Santé de la Recherche Médicale Unit 403 (P.G.), Lyon, France; Department of Medicine (J.P.B.), College of Physicians and Surgeons, Columbia University, New York, New York 10027; University of Pittsburgh (S.L.G.), Pittsburgh, Pennsylvania 15213; Departments of Medicine and Epidemiology (K.E.E.), Minneapolis Veterans Affairs Medical Center and University of Minnesota, Minneapolis, Minnesota 55417; and the Maine Center for Osteoporosis Research (C.J.R.), St. Joseph Hospital, Bangor, Maine 04401

Address all correspondence and requests for reprints to: Dr. D.C. Bauer, University of California, San Francisco Coordinating Center, 185 Berry 5700, San Francisco, California 94107. E-mail: DBauer{at}psg.ucsf.edu.

Context: Treatment of osteoporotic women with PTH increases biochemical markers of bone turnover, increases axial bone mineral density (BMD), and reduces fracture risk.

Objective: Our objective was to determine the relationship between levels of baseline turnover before PTH therapy and short-term changes in turnover during PTH therapy and subsequent changes in areal and volumetric BMD.

Design and Setting: We conducted a randomized, placebo-controlled trial at four academic centers.

Patients: Patients included 238 postmenopausal women with low hip or spine BMD.

Intervention: Subjects were randomized to sc PTH (1–84), 100 µg/d (119 women), for 1 yr.

Main Outcome Measure: Bone turnover markers were measured in fasting blood samples collected before therapy and after 1 and 3 months. Areal and volumetric BMD at the spine and hip were assessed by dual-energy x-ray absorptiometry and quantitative computed tomography (QCT) after 1 yr of therapy.

Results: Among women treated with PTH alone, the relationships between baseline turnover and 1-yr changes in dual-energy x-ray absorptiometry and QCT BMD were inconsistent. Greater 1- and 3-month increases in turnover, particularly the formation marker N-propeptide of type I collagen, were associated with greater increases in areal BMD. When volumetric hip and spine BMD were assessed by QCT, greater short-term increases in turnover were even more positively associated with 1-yr increases in BMD. Each SD increase in the 3-month change of N-propeptide of type I collagen was associated with an a 21% greater increase in QCT spine trabecular BMD.

Conclusions: Greater short-term changes in turnover with PTH therapy are associated with greater 1-yr increases in spine and hip BMD among postmenopausal osteoporotic women.

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