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Relationship of early changes in bone resorption to the reduction in fracture risk with risedronate.
J Bone Miner Res. 2003 Jun; 18(6):1051-6.JB

Abstract

Changes in the level of biochemical markers of bone resorption with risedronate treatment for osteoporosis were examined as a surrogate for the decrease in fracture risk. Greater decreases in bone resorption markers were associated with greater decreases in vertebral (and nonvertebral) fractures. Antifracture efficacy of antiresorptive therapies is only partially explained by increases in bone mineral density. Early decreases in bone resorption may also play a role. We tested this hypothesis by measuring two bone resorption markers, the C-telopeptide of type I collagen (CTX) and the N-telopeptide of type I collagen (NTX), in osteoporotic patients in risedronate vertebral fracture trials. We studied 693 women with at least one vertebral deformity (mean age, 69 +/- 7 years) who received calcium (and vitamin D if required) and placebo or risedronate 5 mg daily for 3 years. The reductions in urinary CTX (median, 60%) and NTX (51%) at 3-6 months with risedronate therapy were significantly associated (p < 0.05) with the reduction in vertebral fracture risk (75% over 1 year and 50% over 3 years). The changes in both CTX and NTX accounted for approximately one-half (CTX, 55%; NTX, 49%) of risedronate's effect in reducing the risk of vertebral fractures in the first year and approximately two-thirds (CTX, 67%; NTX, 66%) over 3 years compared with placebo. The changes in CTX and NTX accounted for 77% and 54%, respectively, of risedronate's effect in reducing the risk of nonvertebral fractures over 3 years compared with placebo. The relationships between vertebral fracture risk and changes from baseline in CTX and NTX were not linear (p < 0.05). There was little further improvement in fracture benefit below a decrease of 55-60% for CTX and 35-40% for NTX. The decrease in bone resorption in patients taking risedronate accounts for a large proportion of the reduction in fracture risk. There may be a level of bone resorption reduction below which there is no further fracture benefit.

Authors+Show Affiliations

Bone Metabolism Group, University of Sheffield, Sheffield, United Kingdom. r.eastell@sheffield.ac.ukNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

12817758

Citation

Eastell, R, et al. "Relationship of Early Changes in Bone Resorption to the Reduction in Fracture Risk With Risedronate." Journal of Bone and Mineral Research : the Official Journal of the American Society for Bone and Mineral Research, vol. 18, no. 6, 2003, pp. 1051-6.
Eastell R, Barton I, Hannon RA, et al. Relationship of early changes in bone resorption to the reduction in fracture risk with risedronate. J Bone Miner Res. 2003;18(6):1051-6.
Eastell, R., Barton, I., Hannon, R. A., Chines, A., Garnero, P., & Delmas, P. D. (2003). Relationship of early changes in bone resorption to the reduction in fracture risk with risedronate. Journal of Bone and Mineral Research : the Official Journal of the American Society for Bone and Mineral Research, 18(6), 1051-6.
Eastell R, et al. Relationship of Early Changes in Bone Resorption to the Reduction in Fracture Risk With Risedronate. J Bone Miner Res. 2003;18(6):1051-6. PubMed PMID: 12817758.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Relationship of early changes in bone resorption to the reduction in fracture risk with risedronate. AU - Eastell,R, AU - Barton,I, AU - Hannon,R A, AU - Chines,A, AU - Garnero,P, AU - Delmas,P D, PY - 2003/6/24/pubmed PY - 2004/2/12/medline PY - 2003/6/24/entrez SP - 1051 EP - 6 JF - Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research JO - J Bone Miner Res VL - 18 IS - 6 N2 - Changes in the level of biochemical markers of bone resorption with risedronate treatment for osteoporosis were examined as a surrogate for the decrease in fracture risk. Greater decreases in bone resorption markers were associated with greater decreases in vertebral (and nonvertebral) fractures. Antifracture efficacy of antiresorptive therapies is only partially explained by increases in bone mineral density. Early decreases in bone resorption may also play a role. We tested this hypothesis by measuring two bone resorption markers, the C-telopeptide of type I collagen (CTX) and the N-telopeptide of type I collagen (NTX), in osteoporotic patients in risedronate vertebral fracture trials. We studied 693 women with at least one vertebral deformity (mean age, 69 +/- 7 years) who received calcium (and vitamin D if required) and placebo or risedronate 5 mg daily for 3 years. The reductions in urinary CTX (median, 60%) and NTX (51%) at 3-6 months with risedronate therapy were significantly associated (p < 0.05) with the reduction in vertebral fracture risk (75% over 1 year and 50% over 3 years). The changes in both CTX and NTX accounted for approximately one-half (CTX, 55%; NTX, 49%) of risedronate's effect in reducing the risk of vertebral fractures in the first year and approximately two-thirds (CTX, 67%; NTX, 66%) over 3 years compared with placebo. The changes in CTX and NTX accounted for 77% and 54%, respectively, of risedronate's effect in reducing the risk of nonvertebral fractures over 3 years compared with placebo. The relationships between vertebral fracture risk and changes from baseline in CTX and NTX were not linear (p < 0.05). There was little further improvement in fracture benefit below a decrease of 55-60% for CTX and 35-40% for NTX. The decrease in bone resorption in patients taking risedronate accounts for a large proportion of the reduction in fracture risk. There may be a level of bone resorption reduction below which there is no further fracture benefit. SN - 0884-0431 UR - https://www.unboundmedicine.com/medline/citation/12817758/Relationship_of_early_changes_in_bone_resorption_to_the_reduction_in_fracture_risk_with_risedronate_ L2 - https://doi.org/10.1359/jbmr.2003.18.6.1051 DB - PRIME DP - Unbound Medicine ER -