The Relationship of Biochemical Markers of Bone Turnover to Bone Density Changes in Postmenopausal Women: Results from the Postmenopausal Estrogen/Progestin Interventions (PEPI) Trial

Marcus, Robert; Holloway, Leah; Wells, Bradley; Greendale, Gail A.; James, Margaret K.; Wasilauskas, Carol H.; Kelaghan, Joseph

doi:10.1359/jbmr.1999.14.9.1583

Cited by 106 publications

(56 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A strong association may not be expected since TBBMC is primarily cortical bone and turnover markers are more indicative of cancellous bone activity. Although some investigators have shown no relationship between markers and bone mass [12], others have shown a small but significant correlation between a higher BMC with lower bone turnover [3,11,13], consistent with our data. Garnero et al [14] have also found a direct association between bone markers and fracture risk.…”

Section: Discussionsupporting

confidence: 91%

Bone turnover and body weight relationships differ in normal-weight compared with heavier postmenopausal women

et al. 2003

View full text Add to dashboard Cite

Low body weight is associated with increased risk for fractures, whereas higher body weight has been shown to be protective against osteoporosis. This study evaluated whether body weight plays a role regulating bone turnover and mass in normal-weight (body mass index (BMI) <25 kg/m 2 ), overweight (BMI 25-29.9 kg/ m 2 ) and obese (BMI ≥ 30 kg/m 2 ) postmenopausal women who were either receiving hormone replacement therapy [HRT(+)] or not [HRT(−)] (total of six groups). Body weight, BMI, total body bone mineral content (TBBMC), and markers of bone formation (serum osteocalcin) and bone resorption (urinary pyridinoline (PYD) and deoxypyridinoline) were retrospectively analyzed in 210 postmenopausal women. The mean age was 67±6 years, with mean body weight of 70.8±14.2 kg, ranging from 45.0 to 115.5 kg. Body weight was positively correlated with TBBMC (r=0.50, p<0.0001). There was a lower TBBMC and higher bone formation rate in normal-weight than obese HRT(−) women, but in women taking HRT there were no differences between BMI categories. In addition, in normal-weight HRT(−) women only, PYD and body weight showed a negative correlation (r=−0.39, p=0.01). Among normal-weight, but not overweight or obese subjects, we observed higher TBBMC and lower bone turnover in the HRT(+) compared with the HRT(−) group. Regression models explained 36% of the variance in TBBMC, mainly through body weight. Additional models could only explain 11-15% of the variance in bone turnover. Taken together, these data suggest that among normal-weight but not obese postmenopausal women, higher bone turnover is associated with lower bone mass, and that only normal-weight women show a different bone turnover profile with HRT treatment. Body weight should be considered an important factor in bone metabolism with relevant clinical implications.

show abstract

Section: Discussionsupporting

confidence: 91%

Bone turnover and body weight relationships differ in normal-weight compared with heavier postmenopausal women

et al. 2003

View full text Add to dashboard Cite

show abstract

“…The contribution (34.4%) of baseline clinical features in this study was higher than that in the PEPI trial [16], in which age, BMI and BMD together accounted for 13% of the percent change in spinal BMD. The majority of subjects of PEPI trial were Caucasians, which may be related to the difference of these contributions.…”

Section: Discussioncontrasting

confidence: 69%

Clinical Features Affecting the Results of Estrogen Replacement Therapy on Bone Density in Japanese Postmenopausal Women

Morishige

Matsumoto

Ohmichi

et al. 2001

Gynecol Obstet Invest

View full text Add to dashboard Cite

Although estrogen replacement therapy (ERT) has been established as an effective treatment for postmenopausal bone loss, the clinical features which predict the effects of ERT have not been well investigated in Japanese postmenopausal women. We analyzed the role of physical factors influencing the effect of ERT on vertebral bone mineral density (BMD) in 94 Japanese postmenopausal women treated for 2 years or longer. The increase in BMD with ERT is 17.6 ± 27.6 mg/cm²/year (mean ± SD) during the first 2 years. Rates of BMD change were negatively correlated with the estimated initial BMD, and positively correlated with age and years since menopause, while no correlation was noted with the body mass index by a simple correlation analysis. The relationships between BMD change and estimated initial BMD or age also held in a multiple regression analysis. The estimated initial BMD and age together accounted for 34.4% of the BMD change during ERT. Furthermore, there were very few (2.4%) nonresponders with a negative linear regression slope of BMD in the osteoporosis and osteopenia group, although 32.7% of the normal initial BMD group were nonresponders. These results suggest that the initial BMD and age are potent predictive factors of the ERT effect on BMD change in Japanese postmenopausal women.

show abstract

“…(25,26) In the Women's Health Initiative (WHI) study of 16,608 women, at 5.2 years combination HT reduced hip and clinical vertebral fractures by 34% and all fractures by 24%. (27) Estrogen-only HT produced a similar reduction in fracture risk.…”

Section: Hormone Therapymentioning

confidence: 99%

Postmenopausal osteoporosis treatment with antiresorptives: Effects of discontinuation or long-term continuation on bone turnover and fracture risk—a perspective

Boonen¹,

Ferrari²,

Miller³

et al. 2012

Journal of Bone and Mineral Research

View full text Add to dashboard Cite

Osteoporosis may be a lifelong condition. Robust data regarding the efficacy and safety of both long-term osteoporosis therapy and therapy discontinuation are therefore important. A paucity of clinical trial data regarding the long-term antifracture efficacy of osteoporosis therapies necessitates the use of surrogate endpoints in discussions surrounding long-term use and/or discontinuation. Long-term treatment (beyond 3-4 years) may produce further increases in bone mineral density (BMD) or BMD stability, depending on the specific treatment and the skeletal site. Bisphosphonates, when discontinued, are associated with a prolonged reduction in bone turnover markers (BTMs), with a very gradual increase to pretreatment levels within 3 to 60 months of treatment cessation, depending on the bisphosphonate used and the prior duration of therapy. In contrast, with nonbisphosphonate antiresorptive agents, such as estrogen and denosumab, BTMs rebound to above pretreatment values within months of discontinuation. The pattern of BTM change is generally mirrored by a more or less rapid decrease in BMD. Although the prolonged effect of some bisphosphonates on BTMs and BMD may contribute to residual benefit on bone strength, it may also raise safety concerns. Adequately powered postdiscontinuation fracture studies and conclusive evidence on maintenance or loss of fracture benefit is lacking for bisphosphonates. Similarly, the effects of rapid reversal of bone turnover upon discontinuation of denosumab on fracture risk remain unknown. Ideally, studies evaluating the effects of long-term treatment and treatment discontinuation should be designed to provide head-to-head ''offset'' data between bisphosphonates and nonbisphosphonate antiresorptive agents. In the absence of this, a clinical recommendation for physicians may be to periodically assess the benefits/risks of continuation versus discontinuation versus alternative management strategies. ß

show abstract

The Relationship of Biochemical Markers of Bone Turnover to Bone Density Changes in Postmenopausal Women: Results from the Postmenopausal Estrogen/Progestin Interventions (PEPI) Trial

Cited by 106 publications

References 17 publications

Bone turnover and body weight relationships differ in normal-weight compared with heavier postmenopausal women

Bone turnover and body weight relationships differ in normal-weight compared with heavier postmenopausal women

Clinical Features Affecting the Results of Estrogen Replacement Therapy on Bone Density in Japanese Postmenopausal Women

Postmenopausal osteoporosis treatment with antiresorptives: Effects of discontinuation or long-term continuation on bone turnover and fracture risk—a perspective

Contact Info

Product

Resources

About