Urinary N-Telopeptides to Monitor Bone Resorption While on GnRH Agonist Therapy

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Abstract
To assess the utility of urinary cross-linked N-telopeptides in monitoring bone resorption and predicting bone loss during GnRH agonist administration. Ninety patients who were prescribed GnRH agonist therapy for 3–6 months for treatment of endometriosis, leiomyomas, or other gynecologic disorders participated in this prospective multicenter study. N-telopeptides, serum estradiol (E2), and bone mineral density were monitored before, during, and up to 3 months after the course of GnRH agonist therapy. N-telopeptide levels increased significantly throughout GnRH agonist therapy and returned to baseline levels by 3 months after treatment was completed. A significant negative correlation was seen between N-telopeptide and E2 measurements after 3 months (r = −0.23, P < .05), 4 months (r = −0.32, P < .05), and 5 months (r = −0.41, P < .005) of GnRH agonist therapy. The percent change in bone mineral density at L1–L4 at 6 months of GnRH agonist treatment correlated inversely with the percent change in N-telopeptides from baseline to 2, 3, 4, and 5 months of treatment; the percent change in bone mineral density at the femoral neck at 6 months correlated inversely with the percent change of N-telopeptides from baseline to month 4. Urinary N-telopeptide determinations provide a quantitative measure of bone resorption, due to GnRH agonist-induced hypoestrogenism. Increases in resorption as measured by N-telopeptides parallel decreases in E2 levels. Increases in N-telopeptides on GnRH agonist therapy may provide a tool to predict decreases in bone mineral density.

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