The Relationship of Subclinical Hypothyroidism with Bone Mineral Density and Biochemical Bone Markers in Postmenopausal Women

BACKGROUND: It is well recognized that thyroid hormone stimulates bone turnover, increasing bone resorption, thus affecting bone mineral density, but few data are available on untreated subclinical hypothyroidism. The aim of this study was to examine whether bone mineral density is increased in postmenopausal subclinical hypothyroidism patients compared with postmenopausal normal thyroid function women, and to evaluate the relationship between thyroid hormones (TSH, FT(4)) and bone mineral density or various biochemical markers of bone metabolism. METHODS: This was a cross sectional study of 132 postmenopausal women aged from 51 to 70 who undertook health screening program in Pundang CHA general hospital from 1996 to 2001. They were divided into two groups; subclinical hypothyroidism group (n=52) and normal thyroid function group (n=80) matched by age. RESULTS: The total bone mineral density was significantly increased in the subclinical hypothyroid group than in the normal group (P<0.05). The serum osteocalcin was lower in the subclinical hypothyroidism group (P<0.05), but neither the alkaline phosphatase nor the deoxypyridinoline showed any significance. For all participants in this study, TSH, but not FT(4), exhibited significant correlation with the total bone mineral density (r=0.188, P<0.05), and with the osteocalcin (r=-0.191, P<0.05). Multiple regression analysis identified the TSH as an independent predictor of the total bone mineral density (beta=0.0410; P< 0.05). CONCLUSION: This study indicated that subclinical hypothyroidism is one of the factors which can elevate bone mineral density in postmenopausal women.

The Increment of Bone Density in Patients with Spinal Cord Injury after Alendronate Therapy

OBJECTIVE: The aim of this study was to investigate the changes of bone mineral density (BMD) according to the postinjury duration, walking ability, and to assess the effect of oral alendronate therapy on BMD and biochemical markers in patients with spinal cord injury. METHOD: Forty-eight subjects with spinal cord injury were enrolled. One tablet of Alend(R) (10 mg of sodium alendronate) was administered daily for 6 months. After this, all subjects received placebo for 6 months as the same manner. The baseline quantitative assessments of BMD and biochemical bone markers, serum osteocalcin and C-terminal telopeptide of type I collagen (ICTP), were performed before the administration of drug. The follow up assessments were performed at 6 and 12 months after drug and placebo administration. RESULTS: The patients treated with oral alendronate showed significantly higher BMD of femur compared with baseline (p <0.05). Also, ICTP showed significant reduction after alendronate therapy. BMD change rate of alendronate therapy was higher in functional ambulation group compared with wheelchair ambulation group. BMD change rate of alendronate therapy was higher than that of placebo administration. CONCLUSION: Alendronate therapy may be useful in prevention of loss of BMD after spinal cord injury.

Effects of Pamidronate Treatment on Osteogenesis Imperfecta / 대한내분비학회지

BACKGROUND: Osteogenesis imperfecta (OI) is a congenital disorder of type I collagen, with variable phenotypes, due to increased bone fragility and low bone mass. Previous pharmacological treatments for OI have been attempted with calcitonin and growth hormone but with little beneficial effects. Recently, Glorieux reported the beneficial effects of bisphosphonates in OI. METHODS: In this study, the effects of pamidronate treatment were evaluated in 9 patients with OI. All patients received intravenous pamidronate infusions, which was dose adjusted according to the patients' age. The outcome measures included the biochemical bone markers; serum alkaline phosphatase, urine deoxy-pyridinoline, urine Ca/Cr ratio, and bone mineral density (BMD). RESULTS: Serum alkaline phosphatase, urine deoxypyridinoline, and urine Ca/Cr ratio were slightly decreased after 1 year of therapy, although these changes were not statistically significant. The BMDs of the lumbar spine and proximal femur were significantly increased after 1-year of pamidronate treatment. No fractures were reported during the 1 year treatment periods. CONCLUSION: Pamidronate treatment had an effect on the BMD in osteogenesis imperfecta, probably due to decreasing bone resorption

The Effects of Alendronate in Bone Metabolism of Primary Osteoporosis / 대한내분비학회지

BACKGROUND: To evaluate the effects of alendronate in preventing bone loss at the spine and hip in Korean cases of primary osteoporosis, we treated 138 patients with 10 mg of alendronate daily. Of the 138 patients treated, 50 were treated for one complete year, and at their final visit, measurements were taken to assess the completed outcome of the reatment, and the results from this small group were compared with those of the rest. The way this has been written causes ambiguity concerning exactly who was being studied. Check that my rewrite of this section conveys correctly the group that was studied, and how. METHODS: The serum levels of calcium(Ca) and phosphorous(P), total alkaline phosphatase(ALP), the urine calcium creatinine ratio(Uca/cr) and urine deoxypyridinoline(DPD) were measured before, during, and after the 1 year treatment period. The bone mineral densities(BMDs) at the spine and hip were also measured before and after the treatment period. New clinical fractures and side effects, were evaluated during the treatment period. RESULTS: The total serum ALP and urine DPD were decreased significantly, after the treatment period, by 38.3 and 40.5% respectively. The bone mineral density at the spine and hip were significantly increased after 1 year, by 6.7 and 2.0%, respectively. Of the 50 subjects who had completed a full year of treatment, only 4(8%) had developed new clinical fractures. Of the 138 patients who had been treated, 8(5.8%) discontinued the medication due to side effects. Of these, 7 had gastrointestinal symptoms, and 1 had skin eruption. CONCLUSION: Alendronate significantly decreased the total serum ALP and urine DPD and significantly increased spine and hip bone mineral density. Alendronate 10mg was effective in preventing bone loss in Korean cases of primary osteoporosis.

Changes of Bone Mineral Density and Biochemical Bone Markers during Perimenopausal Period for Healthy Women: Retrospective Cohort Study

BACKGROUND: Although it is well known that bone mineral density (BMD) loss occurs after menopausal transition, there are only few previous studies that describe differences of BMD and biochemical bone markers in women of pre- and postmenopausal periods. The purpose of this study was to find factors that contribute to loss of BMD after menopause and to show changes of BMD and biochemical bone markers during pre- and postmenopausal periods by retrospective cohort study. METHODS: This retrospective cohort study was performed from Jan. 1995 to Jan. 2001 at a health promotion center. Twenty one healthy perimenopausal women were enrolled. BMD and biochemical bone markers were checked more than two times during the study period. Changes of BMD and biochemical bone markers between pre- and postmenopausal state were compared by paired t-test. Pearson correlation and multiple regression were performed to find the contributing factors to loss of BMD after menopause. RESULTS: Postmenopausal BMD (164.65 36.34 mg/cm3) was significantly decreased to 16.49 16.91 mg/cm3 (P<0.001) as compared with premenopausal BMD (181.14 40.81 mg/cm3). In biochemical bone markers only urine deoxypyridinoline had a significant difference (3.30 3.97 nMDP/mMcre, P<0.05) Only premenopausal BMD contributed to decreasing rate of BMD between the two states and the loss of BMD after menopause (P<0.05). CONCLUSION: In perimenopausal healthy women, postmenopausal BMD was significantly decreased as compared with premenopausal BMD. And only premenopausal BMD was shown to be a contributing factor to decreasing rate of BMD between the two states and the loss of BMD after menopause. It suggests that premenopausal BMD is important in predicting postmenopausal osteoporosis and efforts to prevent loss of BMD before menopause can prevent progress of postmenopausal osteoporosis.

The Usefulness of Biochemical Markers of Bone turnover for Bone Mineral Density in Early Postmenopausal Women Treated with Hormone Replacement or Calcium Supplementation / 대한산부인과학회잡지

OBJECTIVE: To identify the effectiveness of bone turnover indexes for bone loss or gain in early postmenopausal women. METHOD: This study was performed in 240 menopausal women(mean age, 50 yr), who were randomized to hormone replacement therapy(HRT) or calcium supplementation(CS, 500mg/day) for 1yr. Urinary N-telopeptide(NTx) and osteocalcin(OC), as well as spine and femoral neck bone mineral density(BMD) were measured at baseline and 1, 3, 6, 12 months after treatment. RESULTS: Women receiving HRT(n=110) showed a significant increase in spine BMD(+2.6%; P<0.0001) and hip BMD(+1.1%; P<0.05) compared to women receiving CS, who showed a decline at both sites (-1.0%; P<0.01). Both markers showed time dependent decreases in women receiving HRT(P<0.001) and no change in women receiving calcium alone. When baseline indexes of turnover were divided by quartile, there was a significantly greater increase in BMD among those with the highest NTx, OC levels compared to that in those with the lowest NTx, OC levles(P<0.05). When subjects receiving HRT were compared by their positive or negative skeletal response at 1yr and their baseline turnover marker, initial NTx values were significantly higher in those that gained bone than in those that lost bone (P<0.001). Calcium supplementation women in the highest quartile for NTx at baseline had significantly greater decreases in spine BMD than subjects with the lowest NTx values(P<0.005). CONCLUSIONS: For early postmenopausal women there are differential responses of biochemical markers to HRT and calcium supplementation. Baseline urinary NTx and serum osteocalcin were good predictors of change in spine BMD after 1yr of either HRT or calcium supplementation. It is concluded that markers of bone formation and resorption can be used clinically to predict future BMD in early postmenopausal women.

The changes of bone mineral density and biochemical bone markers after GnRH agonist treatment in patients with endometriosis / 대한산부인과학회잡지

OBJECTIVE: To investigate the basal bone mineral density(BMD)s of the lumbar spine and femur of patients with endometriosis, and the changes of BMDs and biochemical bone markers after 6 months of gonadotropin releasing hormone(GnRH) agonist treatment. METHODS: The initial BMDs of 35 women with endometriosis were measured by dual energy x-ray absorptiometry at department of obstetrics & gynecology Yongsan Hospital, College of Medicine, Chung Ang University from April 1996 to May 1999. 19 patients of these group was repeatedly measured after 3.6mg subcutaneous depot injection of goserelin(Zoladex) every 4 weeks for 24 weeks. Osteocalcin and Deoxypyridinoline were measured before goserelin treatment, at 3 months, and at 6 months completion of goserelin treatment. RESULTS: Patients with endometriosis did not show the significant difference in mean BMD of lumbar spine and femur in comparison with age matched normal women. Patients treated with goserelin for 6 months showed 0.064+/-0.030g/cm2(5.56%) decrease of BMD in lumbar spine, 0.038+/-0.040g/cm2(3.85%) decrease in femur neck, 0.055+/-0.047g/cm2(6.10%) decrease in Ward triangle, 0.041+/-0.031g/cm2(5.19%) decrease in femoral trochanter. These data had statistical significance(p<0.001). At first 3 months and on completion of 6 months goserelin treatment, there were increase of 66.1%, 122.3% in serum osteocalcin respectively, and increase of 35.2%, 39.6% in urine deoxypyridinoline respectively, compared with pretreatment value. CONCLUSION: From these results, it is concluded that the BMDs of patients with endometriosis were normal, and after 6 months GnRH agonist treatment, bone loss was 3.85%-6.10%, and the values of biochemical bone markers were increased.

Alterations of bone mineral density and bone turnover in patients with Cushing's syndrome / 대한내과학회지

BACKGROUND: Although it is generally accepted that high serum glucocorticoid levels causes osteoporosis by suppressing the bone formation, conflicting results have reported on bone resorption. But, previous studies have been carried out in patients with glucocorticoid excess secondary to exogenous glucocorticoid treatment of disorders, which also affect bone turnover and mass by themselves. The purpose of this study were to assess the effect of glucocorticoid excess on bone mass and turnover not influenced by other diseases known to affect skeleton and by different gonadal status and sex and to study the reversibility of osteopenia after cure of Cushing's syndrome. METHODS: We measured bone mineral density using dual energy X-ray absorptiometry(DEXA) in 28 patients with Cushing's syndrome before and after surgical cure. In addition, in the patients with Cushing's syndrome and 21 healthy premenopausal women matched for age, we measured biochemical bone markers. RESULTS: 1) Marked osteopenia was present in most patients with active Cushing's syndrome. Lumbar spine BMD and Ward's triangle BMD were significantly lower than femoral neck BMD and femoral great trochanter BMD.(Z-score: lumbar spine -2.22+/-1.17, femoral neck -0.71+/-1.08, Ward's triangle -1.77+/-0.97, femoral great trochanter -0.64+/-0.71; mean+/-SD, p 0.05). 3) When compared with pretreatment values, BMD after surgical cure of Cushing's syndrome was increased significantly(p< 0.05). Serum osteocalcin was increased and urinary N-telopeptide was decreased significantly(p< 0.05). CONCLUSION: These results show that compared to age matched control, premenopausal Cushing's syndrome patients have reduced bone formation, increased bone resorption, and reduced BMD, especially trabecular bone and that these abnormalities are improved after surgical cure.

Changes of Biochemical Bone Markers and Bone Mineral Density after Hormone Replacement Therapy in Korean Women / 대한내분비학회지

BACKGROUND: Biochemical bone markers have been suggested to reflect postmenopausal high bone turnover. These markers could be useful in following response to hormone replacement therapy (HRT). But we have few studies about the sequential changes of biochemical bone markers and bone mass after HRT in Korean women, and it is unclear whether women with early menopause have different response to HRT from women with normal menopause. The aims of the present study were to see the sequential changes of biochemical bone markers and bone mass after HRT in Korean women, to examine whether a single baseline biochemical bone marker or a change in biochemical bone marker could predict subsequent bone mass, and to determine the difference of response to HRT between women with early menopause and women with normal menopause. METHODS: Postmenopausal women (n=21) were divided with into three groups according to their age at menopause (AAM): the first group with AAM or = 50 years (normal menopause group, n=10). For the HRT, conjugated estrogen (0.625mg per day) and continuous or cyclic medroxyprogesterone (2.5-10mg per day) were administered. Bone mineral density (BMD) was measured at baseline and 12 months and biochemical bone markers were measured at baseline and 3, 6, and 12 months during HRT. RESULTS: Deoxypyridinoline, type 1 collagen N-telopeptide, bone alkaline phosphatase, and osteocalcin were significantly decreased at 3 months, and mean percent changes from baseline of bone resorption markers were larger than those of bone formation markers. At 12 months, BMD was significantly increased at lumbar spine and Ward's triangle. But BMD was not significantly increased at femur neck and femur trochanter. Two baseline bone markers (bone alkaline phosphatase and type 1 collagen N-telopeptide) correlated with changes of BMD but any changes of bone markers at 3, 6 months didn't correlate with changes of BMD. In early menopause group, changes of bone markers and BMD were larger than those in normal menopause group, but the difference between the two groups was not significant. CONCLUSION: All four bone markers showed significant reduction at 3 months, but bone resorption markers were decreased more markedly and rapidly, and some baseline bone markers can predict the change of BMD after HRT. The difference of response to HRT between early menopause group and normal menopause group was not significant.

Influence of Early Age at Menopause on Bone Mineral Density and Biochemical Bone Marker / 대한내분비학회지

BACKGROUND: Among the various factors affecting bone mass and bone metabolism, aging and menopause play a major role. After the disappearance of the menstrual cycle, estrogen deficiency is the most important factor in bone loss. It is still unclear whether women with early menopause have a rate of bone loss different from women whose menopause has occurred later. Various biochemical bone markers are increased after menopause but it is still unclear whether women with early menopause have biochemical bone markers different from women whose menopause has occurred later. The aim of this study was to establish whether healthy women with early or normal menopause have different bone mass, biochemical bone markers and rates of bone loss. METHODS: Postmenopausal healthy women were divided into two groups according to their age at menopause(AAM): one group with AAM > 43 years, and the other group with AAM 50 years. Bone mass was measured using a dual energy X-ray absorptiometry(DEXA) in the lumbar, femur neck, femur trochanter, and Wards triangle. Serum levels of bone alkaline phosphatase and osteocalcin, and urine levels of calcium, deoxypyridinoline and type I collagen N-telopeptide were measured using a commercial kit. RESULTS: Age and body mass index in the early menopause group were different from those in the normal menopause group. All the bone mass and the biochemical bone markers in the early menopause group were not different from those in the normal menopause group. We selected 15 subjects from the two groups matched by age and BML Bone mass of femur neck in the early menopause group was lower than in the normal menopause group matched by age and BMI. Bone mass in lumbar, femur trochanter, and Wards triangle was lower in the early menopause group than in the normal menopause group, but the difference between the two groups was not significant. After adjusting years since menopause, we didnt find the difference of bone mass between the two groups. All the bone biochemical markers were not different in the two groups matched by age and BMI. CONCLUSION: Our data suggest that women with early menopause dont lose bone faster than women with normal menopause.