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Baseline bone turnover marker levels can predict change in bone mineral density during antiresorptive treatment in osteoporotic patients: the Copenhagen bone turnover marker study

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Abstract

Summary

Anti-resorptive osteoporosis treatment might be more effective in patients with high bone turnover. In this registry study including clinical data, high pre-treatment bone turnover measured with biochemical markers was correlated with higher bone mineral density increases. Bone turnover markers may be useful tools to identify patients benefitting most from anti-resorptive treatment.

Introduction

In randomized, controlled trials of bisphosphonates, high pre-treatment levels of bone turnover markers (BTM) were associated with a larger increase in bone mineral density (BMD). The purpose of this study was to examine this correlation in a real-world setting.

Methods

In this registry-based cohort study of osteoporosis patients (n = 158) receiving antiresorptive therapy, the association between pre-treatment levels of plasma C-telopeptide of type I Collagen (CTX) and/or N-terminal propeptide of type I procollagen (PINP) and change in bone mineral density (BMD) at lumbar spine, total hip, and femoral neck upon treatment was examined. Patients were grouped according to their pre-treatment BTM levels, defined as values above and below the geometric mean for premenopausal women.

Results

Pre-treatment CTX correlated with annual increase in total hip BMD, where patients with CTX above the geometric mean experienced a larger annual increase in BMD (p = 0.008) than patients with CTX below the geometric mean. The numerical pre-treatment level of CTX showed a similar correlation at all three skeletal sites (total hip (p = 0.03), femoral neck (p = 0.04), and lumbar spine (p = 0.0003)). A similar association was found for PINP where pre-treatment levels of PINP above the geometric mean correlated with a larger annual increase in BMD for total hip (p = 0.02) and lumbar spine (p = 0.006).

Conclusion

Measurement of pre-treatment BTM levels predicts osteoporosis patients’ response to antiresorptive treatment. Patients with high pre-treatment levels of CTX and/or PINP benefit more from antiresorptive treatment with larger increases in BMD than patients with lower pre-treatment levels.

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Authors and Affiliations

  1. Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark

    S. E. Bønløkke, M. S. Rand, C. D. Smith, K. H. Rubin & B. Abrahamsen

  2. Department of Clinical Biochemistry, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark

    S. E. Bønløkke, M. S. Rand & N. R. Jørgensen

  3. Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark

    B. Haddock & P. S. Oturai

  4. Medical Department, National Research Center for Bone Health, Zealand University Hospital Køge, Køge, Denmark

    S. Arup & M. F. Hitz

  5. Department of Endocrinology, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark

    J. E. B. Jensen

  6. Department of Endocrinology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark

    P. Schwarz

  7. Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark

    P. Schwarz, S. Møller, M. F. Hitz & N. R. Jørgensen

  8. Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark

    P. Hovind

  9. Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital Herlev, Herlev, Denmark

    L. T. Jensen

  10. Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark

    S. Møller

  11. Department of Endocrinology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark

    P. Eiken

  12. OPEN - Open Patient Data Explorative Network, Odense University Hospital, Odense, Denmark

    K. H. Rubin

  13. Department of Medicine, Holbæk Hospital, Holbæk, Denmark

    B. Abrahamsen

  14. Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK

    B. Abrahamsen

Authors
  1. S. E. Bønløkke
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  2. M. S. Rand
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  3. B. Haddock
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  4. S. Arup
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  5. C. D. Smith
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  6. J. E. B. Jensen
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  7. P. Schwarz
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  8. P. Hovind
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  9. P. S. Oturai
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  10. L. T. Jensen
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  11. S. Møller
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  12. P. Eiken
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  13. K. H. Rubin
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  14. M. F. Hitz
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  15. B. Abrahamsen
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  16. N. R. Jørgensen
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Corresponding author

Correspondence to N. R. Jørgensen.

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Conflicts of interest

Niklas Rye Jørgensen declares that he has previously received assays as a donation from IDS Plc and Roche for research use but has no further conflict of interest. PE serves on the advisory board of UCB and Gedeon-Richter. BA reports speakers’ fees or consulting fees from Amgen, UCB, Kyowa-Kirin, Pharmacosmos, and Gedeon Richter and institutional research grants from UCB, Kyowa-Kiring, and Gedeon Richter. JEBJ reports advisory board membership in Eli Lilly, Amgen, Gedeon Richter, and UCB; received funding from Eli Lilly, Amgen, Alexion, and Samsung; and speaker’s fees from Eli Lilly, UCB, Amgen, Gedeon Richter, and Osaka. SEB, MSR, BH, SA, CDS, PH, PSO, LTJ, SM, KHR, and MFH have no conflicts of interest relevant to this study to declare.

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Bønløkke, S.E., Rand, M.S., Haddock, B. et al. Baseline bone turnover marker levels can predict change in bone mineral density during antiresorptive treatment in osteoporotic patients: the Copenhagen bone turnover marker study. Osteoporos Int 33, 2155–2164 (2022). https://doi.org/10.1007/s00198-022-06457-0

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  • DOI: https://doi.org/10.1007/s00198-022-06457-0

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