title: Biochemical markers of bone turnover in patients with spinal metastases after resistance training under radiotherapy--a randomized trial.
abstract: BACKGROUND
  To compare the effects of resistance training versus passive physical therapy on bone turnover markers (BTM) in the metastatic bone during radiation therapy (RT) in patients with spinal bone metastases. Secondly, to evaluate an association of BTM to local response, skeletal-related events (SRE), and number of metastases.
  
  
  METHODS
  In this randomized trial, 60 patients were allocated from September 2011 to March 2013 into one of the two arms: resistance training (Arm A) or passive physical therapy (Arm B) with thirty patients in each arm during RT. Biochemical markers such as pyridinoline (PYD), desoxy-pyridinoline (DPD), bone alkaline phosphatase (BAP), total amino-terminal propeptide of type I collagen (PINP), beta-isomer of carboxy-terminal telopeptide of type I collagen (CTX-I), and cross-linked N-telopeptide of type I collagen (NTX) were analyzed at baseline, and three months after RT.
  
  
  RESULTS
  Mean change values of PYD and CTX-I were significantly lower at 3 months after RT (p = 0.035 and p = 0.043) in Arm A. Importantly, all markers decreased in both arms, except of PYD and CTX-I in arm B, although significance was not reached for some biomarkers. In arm A, the local response was significantly higher (p = 0.003) and PINP could be identified as a predictor for survivors (OR 0.968, 95%CI 0.938-0.999, p = 0.043). BAP (OR 0.974, 95%CI 0.950-0.998, p = 0.034) and PINP (OR 1.025, 95%CI 1.001-1.049, p = 0.044) were related with an avoidance of SRE.
  
  
  CONCLUSIONS
  In this group of patients with spinal bone metastases, we were able to show that patients with guided resistance training of the paravertebral muscles can influence BTM. PYD and CTX-I decreased significantly in arm A. PINP can be considered as a complementary tool for prediction of local response, and PINP as well as BAP for avoidance of SRE.
  
  
  BACKGROUND
  Clinical trial identifier NCT 01409720. August 2, 2011.
authors.affiliation: Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany. harald.rief@med.uni-heidelberg.de.
authors.forename: Harald
authors.initials: H
authors.lastname: Rief
authors.affiliation: Department of Orthopaedics and Trauma Surgery, University Hospital of Heidelberg, Schlierbacherstrasse 120a, 69118, Heidelberg, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Omlor
authors.affiliation: Department of Orthopaedics and Trauma Surgery, University Hospital of Heidelberg, Schlierbacherstrasse 120a, 69118, Heidelberg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Akbar
authors.affiliation: Department of Medical Biometry, University Hospital of Heidelberg, Im Neuenheimer Feld 305, 69120, Heidelberg, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Bruckner
authors.affiliation: Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Rieken
authors.affiliation: Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
authors.forename: Robert
authors.initials: R
authors.lastname: Förster
authors.affiliation: Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
authors.forename: Ingmar
authors.initials: I
authors.lastname: Schlampp
authors.affiliation: Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Welzel
authors.affiliation: Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
authors.forename: Tilman
authors.initials: T
authors.lastname: Bostel
authors.affiliation: Department of Endocrinology/Oncology, Limbach Laboratory Heidelberg, Im Breitspiel 15, 69126, Heidelberg, Germany.
authors.forename: Heinz Jürgen
authors.initials: HJ
authors.lastname: Roth
authors.affiliation: Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Debus
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000469:Alkaline Phosphatase / Q000097:blood; D000596:Amino Acids / Q000097:blood; D001859:Bone Neoplasms / Q000097:blood / Q000503:physiopathology / Q000556:secondary / Q000628:therapy*; D016723:Bone Remodeling; D024042:Collagen Type I / Q000097:blood; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010446:Peptide Fragments / Q000097:blood; D010455:Peptides / Q000097:blood; D026741:Physical Therapy Modalities; D011347:Procollagen / Q000097:blood; D055070:Resistance Training; D013131:Spine / Q000473:pathology
chemical_list: D000596:Amino Acids; D024042:Collagen Type I; D010446:Peptide Fragments; D010455:Peptides; D011347:Procollagen; C052929:collagen type I trimeric cross-linked peptide; C047202:procollagen Type I N-terminal peptide; C015484:pyridinoline; D000469:Alkaline Phosphatase
keywords: Biochemical markers; Bone metastases; Physical exercise; Resistance training; Spine