Elevated baseline CTX levels predict enhanced therapeutic efficacy of zoledronic acid in augmenting lumbar spine bone mineral density among Chinese osteoporosis patients

The Summary This study examined the link between baseline CTX levels and zoledronic acid's effectiveness in boosting bone density in osteoporosis patients. Among 472 Chinese patients, higher initial CTX levels correlated with greater lumbar spine bone density improvement after treatment. However, no such correlation was found for hip or femoral neck bones. This suggests CTX levels may aid in treatment selection for lumbar spine, though further research is needed. The findings have clinical implications for optimizing osteoporosis treatment. Purpose To elucidate the correlation between baseline CTX levels and the therapeutic efficacy of zoledronic acid in augmenting bone mineral density (BMD) among individuals with osteoporosis. Methods This study studied patients diagnosed with primary osteoporosis who were hospitalized at least twice and received annual zoledronic acid therapy. Patients were stratified into three groups based on their initial CTX levels prior to zoledronic acid administration. ANOVA was employed to compare BMD alterations across the groups. Generalized estimating equations (GEE) were utilized to analyze the relationship between baseline CTX levels and subsequent BMD changes post-zoledronic acid treatment. Statistical analyses were conducted using SPSS version 26.0. Results A total of 472 patients were evaluated and categorized into three cohorts according to their initial CTX levels, arranged in ascending order. Notably, group 3, characterized by the highest initial CTX levels, demonstrated a significantly more pronounced increase in lumbar spine BMD compared to the other two groups. Specifically, when group 1 served as the reference, group 3 exhibited a 0.4-unit elevation in lumbar spine T-score. Conversely, no discernible relationship was observed between baseline CTX levels and BMD changes in the hip or femoral neck following zoledronic acid treatment. Conclusions Our findings among a Chinese population indicate that elevated CTX levels, particularly exceeding 0.480 ng/ml, are notably associated with enhanced therapeutic efficacy of zoledronic acid in boosting lumbar spine BMD. However, this correlation appears less robust with respect to improvements in hip and femoral neck BMD.