A Study On The Therapeutic Effect Of Different Anti-Osteoporosis Drugs In Different Bone Turnover States Based On The Bone Turnover Markers

Objective:Osteoporosis(OP)is a general bone disease characterized by low bone mass,low bone mineral density(BMD)and microstructural destruction of bone tissue,resulting in increased bone fragility and fracture risk.The pathogenesis of OP is sophisticated.Among the influences,the worsening bone health of the elderly population and the decreasing sex hormone level of menopausal women are closely related to OP,one of the main factors affecting the quality of life of the elderly.At present,the clinical-used anti-osteoporosis drugs can be classified into two types according to the mechanism of action:anti-osteoclast drugs and bone-forming drugs.Bone turnover markers(BTM)can reflect the bone turnover state.But for now,there are few clinical studies focusing on drugs to achieve the best effects for patients under different bone turnover states.Therefore,OP patients can be divided into different bone turnover states according to bone turnover markers.To clarify the therapeutic effect of different anti-osteoporosis drugs in different bone turnover states is of great practical significance to clinical application of anti-osteoporosis drugs.The Objective of this study is to compare the treatment status of two different anti-osteoporosis drugs under three bone turnover states according to the bone turnover markers for the individual,standard and efficient clinical drug selection in treatment of osteoporosis.Methods:Using the Large sample prospective randomized controlled clinical study,and According to the levels of Procollagen type 1 amino-terminal propeptide(P1NP)and Collagen type 1 carboxy-terminal propeptide ?-crosslaps(?-crossLaps),the bone turnover markers(BTM)in serum,200 patients with osteoporosis were grouped into the high bone turnover group(n=50),the low bone turnover group(n=50)and the middle bone turnover group(n=100),who were given two teriparatide(20 ? g/d)and zoledronic acid injection(5 mg/year)respectively.During the one year treatment period,P1NP,?-crossLaps,the bone mineral density(BMD)of lumbar vertebrae,the BMD of femoral neck and visual analogue scale(VAS)were observed and recorded at regular intervals.Results:1.In every group,P1NP and ?-crossLaps significantly increased after treatment with teriparatide(P<0.01),and the markers mentioned above obviously decreased after treatment with zoledronic acid(P<0.01).2.In high bone turnover group,the BMD of lumber vertebrae and femoral neck significantly increased after treatment with zoledronic acid(P<0.01).In low and middle groups,the BMD of lumber vertebrae and femoral neck conspicuously increased after treatment with teriparatide(P<0.01),and the BMD of femoral neck slightly increased after 6-month treatment with zoledronic acid in the middle group(P<0.05).In the groups with effective changes in BMD,the BMD of femoral neck increased more obviously after treatment of zoledronic acid than teriparatide and the BMD of lumber vertebrae increased more significantly after treatment of teriparatide than zoledronic acid(P<0.05)3.In the high group,the bone pain relief by zoledronic acid was better than teriparatide(P<0.05),but in the low and middle groups,the contrary is the case(P<0.05).Conclusion:1.According to the bone turnover markers,the bone turnover states can be classified so as to select the more suitable anti-osteoporosis drugs.2.In the high bone turnover state,anti-osteoclasts(such as zoledronic acid)should be mainly used.For the middle and low states,bone-forming drugs(such as teriparatide)are more effective.