Correlation between Bone Turnover Markers and Bisphosphonates Treatment in Postmenopausal Osteoporosis

Abstract

Objective: To find out the significance of bone turnover markers in management of osteoporotic patients and
correlation to bisphosphonate treatments.
Design: Comparative, prospective, managerial
Setting: Karachi Institute of Radiotherapy and Nuclear Medicine (KIRAN), Karachi.
Material and Methods: A total of 180 post-menopausal women were selected for the study by taking the verbal
consent. Test patients were divided into five groups of 30 patients each on the basis of medicines they receive.
Bisphosphonates (alendronates and risedronates) were prescribed to the patients under different brand names as
fosamax, drate, osto, dronate and actonel. Serum osteocalcin, alkaline phosphatase and c-telopeptidase were
selected as bone turnover markers and were assessed quarterly to find out the correlation between these markers
and different treatment groups.
Results: The selected bone turnover markers i.e, alkaline phosphatase, osteocalcin & c-telopeptide were found to
drop continuously at different rates in all patients undergoing treatment while in controls these markers
remained same with no significant changes throughout the year. The maximum fraction drop was found in
telopeptide levels and minimum drop in alkaline phosphatase, while osteocalcin levels were lying in between.
Conclusion: Results showed that ALP is a good marker for indicating drug compliance but is weak for response
prediction, at 3 and 6 months. Osteocalcin has slightly less sensitivity but better specificity therefore considered
as moderate value marker. However, c-telopeptide showed high sensitivity and specificity as early as 3 months
and thus can be considered as an excellent and high value marker for predicting treatment response.