May 18, 2021Journal of Orthopaedic Surgery and Research155 citationsOpen Access
Biomarkers as therapy monitoring for postmenopausal osteoporosis: a systematic review
Key Result
Higher levels of bone alkaline phosphatase (bALP) were significantly associated with lower femoral bone mineral density (r = -0.87, P = 0.01) in patients treated for postmenopausal osteoporosis.
Study Design
Type
Systematic Review (n=14,446)
Structured PICO
Do biochemical markers of bone turnover (bALP, PINP, bCTx, NTx) correlate with clinical outcomes and adverse events in patients treated for postmenopausal osteoporosis?
P
Population
14,446 patients with postmenopausal osteoporosis from 16 RCTs, median age 67 years, median BMI 25.4 kg/m2.
I
Intervention
Therapy monitoring using biochemical markers of bone turnover (bALP, PINP, bCTx, NTx)
O
Outcome
Associations between biomarkers (bALP, PINP, bCTx, NTx) and clinical outcomes (BMD, rate of fractures, adverse events) at last follow-upsurrogate
Biochemical markers of bone turnover, specifically bALP and NTx, correlate with femoral BMD and non-vertebral fractures, supporting their use in monitoring postmenopausal osteoporosis therapy.
Main Result
Effect estimate: r = -0.87
p-value: p=0.01
Limitations
- Analyses were performed regardless to the drug type and administration
- Heterogeneous daily administration of vitamin D and calcium across included studies
- None of the included articles aimed to quantify directly the biomarkers' variations as a primary outcome
- Biological variability of biochemical markers of bone turnover (BTMs)
Abstract
BACKGROUND: Biochemical markers of bone turnover (BTMs), such as bone alkaline phosphatase (bALP), procollagen type I N propeptide (PINP), serum cross-linked C-telopeptides of type I collagen (bCTx), and urinary cross-linked N-telopeptides of type I collagen (NTx), are commonly used for therapy monitoring purposes for osteoporotic patients. The present study evaluated the potential role of BTMs as therapy monitoring. METHODS: All randomized clinical trials (RCTs) comparing two or more pharmacological treatments for postmenopausal osteoporosis were accessed. Only studies that reported the value of bALP, PINP, bCTx, and NTx at last follow-up were included. A multivariate analysis was performed to assess associations between these biomarkers and clinical outcomes and rate of adverse events in patients with postmenopausal osteoporosis. A multiple linear model regression analysis through the Pearson product-moment correlation coefficient was used. RESULTS: . The ANOVA test found optimal within-group variance concerning mean age, body mass index, and BMD. Greater bALP was associated with lower femoral BMD (P = 0.01). Greater NTx was associated with a greater number of non-vertebral fractures (P = 0.02). Greater NTx was associated with greater rate of therapy discontinuation (P = 0.04). No other statistically significant associations were detected. CONCLUSION: Our analysis supports the adoption of BTMs in therapy monitoring of osteoporotic patients. LEVEL OF EVIDENCE: Level I, systematic review of RCTs.
Cite This Study
Migliorini et al. (Tue,) conducted a systematic review in Postmenopausal osteoporosis (n=14,446). Therapy monitoring with biochemical markers of bone turnover (bALP, PINP, bCTx, NTx) was evaluated on Correlation between bALP and femoral BMD (r = -0.87, p=0.01). Higher levels of bone alkaline phosphatase (bALP) were significantly associated with lower femoral bone mineral density (r = -0.87, P = 0.01) in patients treated for postmenopausal osteoporosis.