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An evaluation of several biochemical markers for bone formation and resorption in a protocol utilizing cyclical parathyroid hormone and calcitonin therapy for osteoporosis.

Publication ,  Journal Article
Hodsman, AB; Fraher, LJ; Ostbye, T; Adachi, JD; Steer, BM
Published in: J Clin Invest
March 1993

Female patients (n = 20) with osteoporosis, aged 66 +/- 5 yr were studied during a 24-h infusion of parathyroid hormone (PTH [1-34]) at a rate of 0.5 IU equivalents/kg.h, and then during a 28-d period of subcutaneous injections, at a dose of 800 IU equivalents per day. Thereafter half the patients received subcutaneous injections of calcitonin, 75 U/d for 42 d, and all patients were followed to the end of a 90-d cycle. Biochemical markers of bone formation (serum alkaline phosphatase, osteocalcin, and the carboxy-terminal extension peptide of pro-collagen 1) and bone resorption (fasting urine calcium, hydroxyproline, and deoxypyridinoline) were compared during treatment by the intravenous and subcutaneous route of PTH administration, and subsequently during calcitonin therapy. During intravenous PTH infusion there were significant reductions in all three bone formation markers, despite expected rises in urinary calcium and hydroxyproline. By contrast, the circulating markers of bone formation increased rapidly by > 100% of baseline values during daily PTH injections (P < 0.001). Significant increases in bone resorption markers were only seen at the end of the 28 d of injections, but were < 100% over baseline values, (P < 0.05). Quantitative bone histomorphometry from biopsies obtained after 28 d of PTH treatment confirmed that bone formation at both the cellular and tissue levels were two to five times higher than similar indices measured in a control group of biopsies from untreated osteoporotic women. Subsequent treatment of these patients with calcitonin showed no significant changes in the biochemical markers of bone formation and only a modest attenuation of bone resorption. Thus, PTH infusion may inhibit bone formation, as judged by circulating biochemical markers, whereas daily injections confirm the potent anabolic actions of the hormone. Sequential calcitonin therapy does not appear to act synergistically with PTH in cyclical therapeutic protocols.

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Published In

J Clin Invest

DOI

ISSN

0021-9738

Publication Date

March 1993

Volume

91

Issue

3

Start / End Page

1138 / 1148

Location

United States

Related Subject Headings

  • Parathyroid Hormone
  • Osteoporosis
  • Osteocalcin
  • Injections, Subcutaneous
  • Infusions, Intravenous
  • Immunology
  • Hydroxyproline
  • Humans
  • Female
  • Drug Administration Schedule
 

Citation

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Hodsman, A. B., Fraher, L. J., Ostbye, T., Adachi, J. D., & Steer, B. M. (1993). An evaluation of several biochemical markers for bone formation and resorption in a protocol utilizing cyclical parathyroid hormone and calcitonin therapy for osteoporosis. J Clin Invest, 91(3), 1138–1148. https://doi.org/10.1172/JCI116273
Hodsman, A. B., L. J. Fraher, T. Ostbye, J. D. Adachi, and B. M. Steer. “An evaluation of several biochemical markers for bone formation and resorption in a protocol utilizing cyclical parathyroid hormone and calcitonin therapy for osteoporosis.J Clin Invest 91, no. 3 (March 1993): 1138–48. https://doi.org/10.1172/JCI116273.
Hodsman, A. B., et al. “An evaluation of several biochemical markers for bone formation and resorption in a protocol utilizing cyclical parathyroid hormone and calcitonin therapy for osteoporosis.J Clin Invest, vol. 91, no. 3, Mar. 1993, pp. 1138–48. Pubmed, doi:10.1172/JCI116273.

Published In

J Clin Invest

DOI

ISSN

0021-9738

Publication Date

March 1993

Volume

91

Issue

3

Start / End Page

1138 / 1148

Location

United States

Related Subject Headings

  • Parathyroid Hormone
  • Osteoporosis
  • Osteocalcin
  • Injections, Subcutaneous
  • Infusions, Intravenous
  • Immunology
  • Hydroxyproline
  • Humans
  • Female
  • Drug Administration Schedule