Osteoporoz hastalarında salmon kalsitonin tedavisinin serum ve sinovyal sıvı kemik yapım ve yıkım belirteçleri üzerine etkisi

Year 2015, Volume: 49 Issue: 2, 160 - 165, 22.05.2015

Hasan Atbinici Serkan Sipahioglu Nurten Aksoy İslam Baykara Ugur Isikan

https://doi.org/10.3944/AOTT.2015.3035

Abstract

Amaç: Salmon kalsitonin, kalsiyum ve D vitamin tedavisinin osteoporoz hastalarında kemik mineral yoğunluğu, sinovyal sıvı ve serumda kemik yapım ve yıkım belirteçleri üzerine etkisini değerlendirmek amaçlandı.

Çalışma planı: Kemik mineral yoğunluğu ölçümü T skoru -2,5 altında 50–85 yaş arası daha önceden osteoporoz tedavisi almamış 25 hasta çalışmaya dâhil edildi. Hastalar iki gruba ayrıldı. Kalsitonin alan Grup1’de 15 (E/K = 1 /14, ortalama yaş 67) ve kalsitonin almayan Grup 2’de 10 (E/K=3/7, ortalama yaş 68) hasta değerlendirildi. Çalışma başlangıcında ve 1 yıl tedavi sonrasında kan ve sinovyal sıvıdaki fosfor, alkalen fosfataz, kalsiyum, kalsitonin, C-telopeptit (CTx), N-telopeptit (NTx), siyaloprotein ile birlikte kemik mineral yoğunluğu değerlerine bakıldı.

Bulgular: Kalsitonin alan grupta tedavi sonrasında femur boyun kemik mineral yoğunluğu değerinde azalma ve vertebra kemik mineral yoğunluğu değerinde artma olduğu görüldü. Kalsitonin almayan grupta her iki değerde artma vardı. Tedavi sonrası kalsitonin alan hastaların sinovyal sıvısında, kalsitonin, siyaloprotein ve NTx değerlerinde azalma, CTx değerinde değişim saptanmadı. Kalsitonin değerindeki azalma istatiksel olarak anlamlı bulundu. CTx, Siyaloprotein değerinde değişim saptanmadı. Bu değişimler istatiksel olarak anlamlı bulunmadı. Kalsitonin almayan Grup 2’de tedavi sonrası sinovyal sıvısında, kalsitonin değerinde azalma, CTx değerinde artma, NTx, Siyaloprotein değerinde değişim saptanmadı. Bu değişimler istatiksel olarak anlamlı bulunmadı. Her iki grupta da tedavi sonrası parametrelerin serum değerlerindeki değişimler anlamlı bulunmadı.

Çıkarımlar: Osteoporoz hastalarında sinovial sıvı kemik yapım ve yıkım belirteç düzeyleri kalsitonin tedavisinden etkilenmektedir. Bu etkileşimin hangi mekanizmalarla gerçekleştiğini ve osteoporoz eklem kıkırdağı metabolizması arasındaki ilişkiyi açıklayacak daha ileri çalışmalara ihtiyaç vardır.

Keywords

CTx; dansitometre; NTx; osteoporoz; solmon kalsitonin; sinovyal sıvı.

Effects of salmon calcitonin treatment on serum and synovial fluid bone formation and resorption markers in osteoporosis patients

Abstract

Objective: This study aimed to evaluate the effects of salmon calcitonin, and calcium and vitamin Dtreatment on bone mineral density, serum and synovial fluid bone formation and resorption markers in patients with osteoporosis.

Methods: The study was completed with twenty-five osteoporosis patients divided into two groups: The 15 patients comprising Group I (1 male and 14 females; mean age: 67.0±12.0) were administered calcitonin treatment in addition to calcium and vitamin D. The 10 patients in Group II (3 males and 7 females; mean age 68.0±16.0) were administered calcium and vitamin D only. Serum and synovial fluid calcium phosphorus, alkaline phosphatase, calcitonin, C-telopeptide (CTx), N-telopeptide (NTx) and sialoprotein levels, and bone densitometries were determined at the beginning and at the end of one year of treatment.

Results: In the calcitonin and calcium and vitamin D treatment group (Group I), femoral neck density scores were decreased and vertebrae scores were increased after one-year treatment. Both scores were increased in the non-calcitonin group (Group II). In Group I, synovial fluid levels of calcitonin, sialoprotein and NTx were decreased, and synovial fluid CTx levels showed no change. The only decrease that was statistically significant was that in calcitonin levels. In Group II, synovial fluid calcitonin levels were decreased, synovial fluid CTx levels were increased and synovial fluid NTx and sialoprotein level were unchanged. These changes were not statistically significant. Serum changes in the parameters were not statistically significant in either group.

Conclusion: In osteoporosis, salmon calcitonin treatment affects synovial fluid bone formation and absorption marker levels. Advanced studies are needed to evaluate the mechanisms by which this takes place, and to explain the relationship between osteoporosis and articular cartilage metabolism.

Keywords

CTx, densitometry, NTx, osteoporosis, salmon calcitonin, synovial fluid

References

• Miller PD, Zapalovski C. Bone Mineral Density Measurements. In: Henderson JE, Goltzman D, editors. The osteoporosis prim- er. Cambridge; New York: Cambridge University Press; 2004. p. 262-77.
• Clowes JA, Peel NF, Eastell R. The impact of monitoring on ad- herence and persistence with antiresorptive treatment for post- menopausal osteoporosis: a randomized controlled trial. J Clin Endocrinol Metab 2004;89:1117-23.
• Lekkerkerker F, Kanis JA, Alsayed N, Bouvenot G, Burlet N, Ca- hall D, et al. Adherence to treatment of osteoporosis: a need for study. Osteoporosis international: a journal established as result of cooperation between the European Foundation for Osteopo- rosis and the National Osteoporosis Foundation of the USA. 2007;18:1311-7.
• Christiansen C, Lindsay R. Estrogens, bone loss and preserva- tion. Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteopo- rosis and the National Osteoporosis Foundation of the USA. 1990;1:7-13.
• Faulkner KG, McClung MR. Quality control of DXA instru- ments in multicenter trials. Osteoporosis international: a journal established as result of cooperation between the European Foun- dation for Osteoporosis and the National Osteoporosis Founda- tion of the USA. 1995;5:218-27.
• Leggate J, Farish E, Fletcher CD, McIntosh W, Hart DM, Som- merville JM. Calcitonin and postmenopausal osteoporosis. Clin Endocrinol (Oxf ) 1984;20:85-92.
• Delmas PD. Markers of bone turnover for monitoring treatment of osteoporosis with antiresorptive drugs. Osteoporosis interna- tional: a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteo- porosis Foundation of the USA. 2000;11 Suppl 6:66-76.
• Taguchi Y, Gorai I, Zhang MG, Chaki O, Nakayama M, Mina- guchi H. Differences in bone resorption after menopause in Japa- nese women with normal or low bone mineral density: quanti- tation of urinary cross-linked N-telopeptides. Calcif Tissue Int 1998;62:395-9.
• Chesnut CH 3rd, Silverman S, Andriano K, Genant H, Gimona A, Harris S, et al. A randomized trial of nasal spray salmon cal- citonin in postmenopausal women with established osteoporosis: the prevent recurrence of osteoporotic fractures study. PROOF Study Group. Am J Med 2000;109:267-76.
• Overgaard K, Hansen MA, Jensen SB, Christiansen C. Ef- fect of salcatonin given intranasally on bone mass and fracture rates in established osteoporosis: a dose-response study. BMJ 1992;305:556-61.
• Chesnut CH 3rd, Majumdar S, Newitt DC, Shields A, Van Pelt J, Laschansky E, et al. Effects of salmon calcitonin on trabecular microarchitecture as determined by magnetic resonance imaging: results from the QUEST study. J Bone Miner Res 2005;20:1548- 61.
• Overgaard K, Riis BJ, Christiansen C, Pİdenphant J, Johansen JS. Nasal calcitonin for treatment of established osteoporosis. Clin Endocrinol (Oxf ) 1989;30:435-42.
• Hejdova M, Palicka V, Kucera Z, Vlcek J. Effects of alendro- nate and calcitonin on bone mineral density in postmenopausal osteoporotic women. An observational study. Pharm World Sci 2005;27:149-53.
• Stock JL, Avioli LV, Baylink DJ, Chesnut C, Genant HK, Maricic MJ, et al. Calcitonin-salmon nasal spray reduces the incidence of new vertebral fractures in postmenopausal women: three year in- terim results of the PROOF study. Bone Miner Res 1997;12.
• Silverman SL. Calcitonin. Endocrinol Metab Clin North Am 2003;32:273-84.
• Lyritis GP, Ioannidis GV, Karachalios T, Roidis N, Kataxaki E, Papaioannou N, et al. Analgesic effect of salmon calcitonin sup- positories in patients with acute pain due to recent osteoporotic vertebral crush fractures: a prospective double-blind, random- ized, placebo-controlled clinical study. Clin J Pain 1999;15:284- 9.
• Blau LA, Hoehns JD. Analgesic efficacy of calcitonin for vertebral fracture pain. Ann Pharmacother 2003;37:564-70.
• Colpan L, Gur A, Cevik R, Nas K, Sarac AJ. The effect of calci- tonin on biochemical markers and zinc excretion in postmeno- pausal osteoporosis. Maturitas 2005;51:246-53.
• Srivastava AK, Libanati C, Hohmann O, Kriegman A, Baylink DJ. Acute effects of calcitonin nasal spray on serum C-telopeptide of type 1 collagen (CTx) levels in elderly osteopenic women with increased bone turnover. Calcif Tissue Int 2004;75:477-81.
• Trovas GP, Lyritis GP, Galanos A, Raptou P, Constantelou E. A randomized trial of nasal spray salmon calcitonin in men with idiopathic osteoporosis: effects on bone mineral density and bone markers. J Bone Miner Res 2002;17:521-7.
• Ofluoglu D, Karadag-Saygi E, Canbulat C, Gunduz OH, Kul- Panza E, Akyuz G. Early effect of nasal salmon calcitonin on the bone marker Crosslaps. Rheumatol Int 2006;26:288-91.
• Bruyere O, Collette J, Delmas P, Rouillon A, Roux C, Seidel L, et al. Interest of biochemical markers of bone turnover for long-term prediction of new vertebral fracture in postmenopausal osteopo- rotic women. Maturitas 2003;44:259-65.
• Franzén A, Heinegård D. Isolation and characterization of two sialoproteins present only in bone calcified matrix. Biochem J 1985;232:715-24.
• Störk S, Störk C, Angerer P, Kothny W, Schmitt P, Wehr U, et al. Bone sialoprotein is a specific biochemical marker of bone me- tabolism in postmenopausal women: a randomized 1-year study. Osteoporos Int 2000;11:790-6.
• Tekin Y, Bozdemir AE. Biochemical Markers and Their Affecting Factors in Assessing Osteoporosis. Türk Klinik Biyokimya Derg 2005;3:73-83.
• Kalu DN, Cockerham R, Yu BP, Roos BA. Lifelong dietary modu- lation of calcitonin levels in rats. Endocrinology 1983;113:2010- 6.