The Research Of Clinical Significance Of Bone Turnover Markers In The Treatment Of Osteoporosis

Background:Osteoporosis(Osteoporosis,OP)is a kind of systemic bone metabolic disorder characterized by reduced bone mineral density(BMD)and deterioration of bone tissue microstructure,increases the bone brittleness and increased fracture risk ratio.The treatment of osteoporosis drugs according to its mechanism of action,mainly divides into the bone absorption of drugs and promote bone formation.For patients in different bone transformation,promote bone formation in bone resorption drug resistance and drug,what kind of medicine will benefit more,has yet to meet clinical study reports.Objective:Positive contrast promote bone formation drugs and inhibiting bone resorption under the different bone metabolism in patients,analysis of bone metabolic changes,to explore an accurate and effective treatment way for osteoporosis drug treatment.Methods:1 The Medical RecordsThe research object of this collected from June 2015 to June 2016,in shandong university qilu hospital orthopaedic outpatient and hospitalization diagnosis and treatment of 125 patients with osteoporosis,56 cases meet the following criteria included in this study,6 cases of male,female 50 cases.Age distribution between the ages of 60-78,an average of 68.7 +/-6.1 years old.2 Group and the TreatmentGroup standard:according to the ?-crossLaps bone absorption index and bone formation index PINP measurements grouping.(1)low bone transform group:?-crossLaps and PINP decreases(n = 30);(2)high bone transform group:give priority to with higher ?-crossLaps with PINP normal or reduce(n = 26).Treatment:low and high bone transformation group,each group randomly were divided into two kinds of treatments,respectively Teriparatide(PTH 1-34)20?g/d and Azole phosphonic acid injection 5 mg/year.All the groups of oral capsule of calcitriol 0.5 ?g/day,calcium he D 600 mg/day.3 Observe the Evaluation Indicators3.1 Bone turnover markersAll treatment before and after treatment in patients with 1 month,3 months,6 months later,in the morning on an empty stomach blood collection,test bone formation index of PINP and bone absorption index of P-crossLaps.3.2 Lumbar spine and Femoral neck BMD assessmentIn the trial,BMD at Lumbar spine(L1-L4)and Femoral neck was assessed by dual-energy X-ray absorptiometry(DXA,Hologic QDR).Measurements were performed at baseline and 6 month after the beginning of the treatment.3.3 Back Pain VAS Score AssessmentPatients assess their back pain at baseline,at 3 and 6 months,using the VAS score for pain:0 painless;1-4 mild;4 to 6 moderate;7-10 severe pain.3.4 Statistical AnalysisStatistics were calculated with GraphPad Prism 5.0 and the Statistical Package for Social Science for Windows(SPSS)19.Mean and standard deviation(SD)were calculated for continuous variables.Measurement data using t-test analysis and multiple sets of data using one-way ANOVA.A p-value<0.05 was considered statistically significant.Results:1.In both group,the level of PINP and ?-crossLaps were significantly increased from baseline during the therapy with teriparatide;the level of P1NP and P-crossLaps were significantly reduced from baseline during the therapy with zoledronic acid.In low bone turnover group,the measurements of PINP and ?-crossLaps increasing faster treated with teriparatide than zoledronic acid(P<0.05).In low bone turnover group,the measured value of P1NP and ?-crossLaps decreased more significantly treated with teriparatide compared with zoledronic acid(P<0.05).2.6 month later,In low bone turnover group,lumbar spine BMD increments were higher with teriparatide versus zoledronic acid(P<0.05);In high bone turnover group,femoral neck BMD increments were higher with zoledronic acid versus teriparatide(P<0.05).3.6 month later,the bone pain relief better treated with teriparatide than zoledronic acid in low bone turnover group(P<0.05),In high bone turnover group,there was no significant statistically difference between the two drugs(P>0.05).Conclusion:In the treatment of primary osteoporosis,bone turnover markers can be used as the basis for drug selection:low bone turnover state should be applied to anti-resorptive drugs and high bone turnover state use bone-forming drugs.Result:1.In the treatment of primary osteoporosis,bone turnover markers can be used as the basis for drug selection.2.In low bone turnover state should mainly applied to anti-resorptive drugs;In high bone turnover state should mainly use bone-forming drugs.