The Study On Variation Of Bone Metabolism Index During The Process Of Anti-osteoporosis Treatment

Objective: To compare the changes of bone metabolism index before and after thetreatment by using anti-osteoporosis drugs and initially calculate the sensitivity andcharacteristics of each index for forecasting osteoporosis and fractures; To analyze therelativity of among bone metabolism index CTX-I, B-ALP, TRACP-5b and PINP beforemedication treatment; The purpose is to screen out the bone metabolism index that cansensitively discover osteoporosis at its early stage and forecast fractures, by which, powerfulsupport will be provided in clinical application.Objects and Methods:1,The Objects of Study: Patients, of the clinical impatientdepartment of spinal disease department in Zhuhai People's Hospital (within the period ofJanuary2011-September2011). A total of100patients were selected. According to thediagnostic criteria set down by Osteoporosis Committee of China Gerontological Society(have or used to have clinical manifestations of fragility fracture, ostalgia, body shorteningand kyphosis etc, and in accord with positive test of X ray, CT and MRI),86eligible patientswere taken for study. All the patients mentioned above don't have metabolic bone diseases,hyperparathyroidism, diabetes or renal insufficiency, etc.2,The Methods of Study:①Register two tubes of fasting venous blood were drawn in the morning the next day and oneweek later after medication. One tube of the blood was sent to the clinical laboratory of ourhospital for a regular biochemical test of blood calcium (Ca2+), phosphorus (P5+) and alkalinephosphatase (ALP); For the other tube, blood serum was extracted and stored in a-70low-temperature refrigerator after the blood sample was centrifuged. Then Enzyme LinkedImmunosorbent Assay (ELISA) was adopted to test bone metabolism index: TRACP-5b,B-ALP, CTX-I and PINP;②After the first blood draw and on that same day, intramuscularinjection of50IU miacalcic each time daily was given, and one tablet of Caltrate600wasorally taken daily. These medication went on consecutively for a week;③Compare bonemetabolism indexes before and after medication treatment, analyze the relativity ofmetabolism indexes before medication;④Record the changes of symptoms, adverse drug reaction, the occurrence of new fractures and adverse events etc, and safety index of drugs fortesting blood, routine urine, and hepatic and renal function.Results1: After medication, bone metabolism index fell, P＜0.01; When the change rateof bone metabolism index equals to or is bigger than50%and25%, The change of CTX-Iindex are larger than other indexes, P＜0.01;2:Before medication, metabolism indexes of TRACP-5b, B-ALP, CTX-I and PINP hadevident and positive correlation, P＜0.01,through multiple linear regression analysis, thecorrelation between CTX-I and PINP is more evident;3:Bone metabolism index of women patients was evidently higher than that of men patients,and highest in the age group of55-65;4:BMI of patients with fractures was lower than that of patients without fractures, P＜0.05,when fractures happened, each bone metabolism index went up;5:ROC graph for diagnosis and experiment of fragility fracture: area under curve of CTX-Iwas0.77, bigger than that of other indexes.Conclusion: CTX-I has better sensitivity and characteristics in the aspects of monitoringdrug effect and forecasting osteoporosis and fractures etc. Among the four metabolismindexes, the correlation between CTX-I and PINP was best; After fracture, Loss of bone massaccelerated, and thus increased osteoporosis, BMI is one of the protective factors of fragilityfractures, which means the higher BMI is, the lower the fracture rate will be; After fracture,positive anti-osteoporosis treatment can be effective in treating symptoms of patients andimproving the fracture to heal, by which, the quality of life is also enhanced; The test of bonemetabolism is easy, economic and convenient, it is worthy of promotion in clinical application.