title: A longitudinal study of markers of bone turnover in Graves' disease and their value in predicting bone mineral density.
abstract: Whether biochemical markers can predict improvement in reduced bone mineral density (BMD) associated with thyrotoxicosis in unclear. We investigated the relationship between serum osteocalcin (OC), bone-specific alkaline phosphatase (b-ALP), serum deoxypyridinoline (Sdpd) and pyridinoline (Spyr), 24-hour urinary deoxypyridinoline (Udpd), and BMD in 17 thyrotoxic patients during 1 yr of treatment. Coinciding with euthyroidism at 4-8 weeks, there was a peak in b-ALP and OC and a prompt fall into the normal range in Udpd and Sdpd, but not Spyr, levels. Mean b-ALP continued to be raised at week 52 when it was inversely correlated with BMD. Mean BMD rose approximately 6%, P < 0.01, over 1 yr. Coupling indices were calculated as a measure of bone balance and, at diagnosis, was [minus4.26 in favor of bone resorption and rose with treatment in favor of bone formation: weeks 2: -0.23; 4: +4.01; 8: +4.37; 12: +4.44; 24: +2.32; and 52: +1.56. Bone turnover is balanced within 2 weeks of starting treatment for thyrotoxicosis. Udpd accurately indicates thyrotoxic bone resorption. Serum b-ALP indicates continuing bone formation and, at 1 yr, may provide a marker for low BMD. OC, Sdpd, and Spyr are less sensitive in documenting bone remodeling during treatment of thyrotoxicosis.
authors.affiliation: Department of Endocrinology, St. Bartholomew's and the Royal London Hospital, England. ASiddiqi@mds.qmw.ac.uk
authors.forename: A
authors.initials: A
authors.lastname: Siddiqi
authors.forename: J M
authors.initials: JM
authors.lastname: Burrin
authors.forename: K
authors.initials: K
authors.lastname: Noonan
authors.forename: I
authors.initials: I
authors.lastname: James
authors.forename: D F
authors.initials: DF
authors.lastname: Wood
authors.forename: C P
authors.initials: CP
authors.lastname: Price
authors.forename: J P
authors.initials: JP
authors.lastname: Monson
mesh_terms: D000328:Adult; D013956:Antithyroid Agents / Q000627:therapeutic use; D015415:Biomarkers; D015519:Bone Density; D001842:Bone and Bones / Q000378:metabolism*; D002231:Carbimazole / Q000627:therapeutic use; D005260:Female; D005544:Forecasting; D006111:Graves Disease / Q000378:metabolism*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D013971:Thyrotoxicosis / Q000188:drug therapy / Q000378:metabolism
chemical_list: D013956:Antithyroid Agents; D015415:Biomarkers; D002231:Carbimazole