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Submitted on August 1, 2005
Accepted on January 20, 2006
Department of Medicine (D.C.B.) and Epidemiology and Biostatistics (D.C.B., D.M.B. and L.P.), University of California, San Francisco; Synarc and INSERM Unit 403, Lyon, France (P.G.); the Department of Medicine, College of Physicians and Surgeons, Columbia University, New York City (J.P.B.); the University of Pittsburgh, Pittsburgh (S.L.G.); Departments of Medicine and Epidemiology, Minneapolis VA Medical Center and University of Minnesota, Minneapolis (K.E.E.); and the Maine Center for Osteoporosis Research, St. Joseph Hospital, Bangor (C.J.R.)
* To whom correspondence should be addressed. E-mail: DBauer{at}psg.ucsf.edu.
Context: Treatment of osteoporotic women with PTH increases biochemical markers of bone turnover, increases axial BMD and reduces fracture risk.
Objective: 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: Randomized, placebo-controlled trial
Setting: Four academic centers
Patients: 238 post-menopausal women with low hip or spine BMD
Intervention: 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 DXA and QCT after 1 yr of therapy.
Results: Among women treated with PTH alone, the relationships between baseline turnover and 1-year changes in DXA and QCT BMD were inconsistent. Greater 1 and 3-month increases in turnover, particularly the formation marker PINP, 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-year increases in BMD. Each SD increase in the 3-month change of PINP was associated with an a21% greater increase in QCT spine trabecular BMD.
Conclusions: Greater short-term changes in turnover with PTH therapy are associated with greater 1-year increases in spine and hip BMD among postmenopausal osteoporotic women.
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