Bone turnover is adequately suppressed in osteoporotic patients treated with bisphosphonates in daily practice

Table 4 Possible explanations in patients with a decrease ≤ LSC

Patient	CTX baseline (ng/L)	CTX follow up (ng/L)	P1NP baseline (μg/L)	P1NP follow up (μg/L)	Decrease CTX (%)	Decrease P1NP (%)	Possible explanation	Bisphosphonate
1	365	150	35	34	59	3 *	Recent fracture §	Alen
2	250	13	15	11	95	27 *	Prednisone use	Alen
3	209	52	25	20	75	20 *	Alcohol abuse	Alen
4	429	446	54	30	+4 *	44	Paraproteinemia	Iban
5	177	151	85	40	15 *	53	Non-compliance	Ris
6	311	365	45	49	+17 *	+9 *	Non-compliance	Alen

Values of CTX and P1NP, type of bisphosphonate and possible explanation in patients that did not decrease ≥ LSC during treatment with a bisphosphonate in the first few months.
* a decrease of CTX or P1NP < LSC
§ during the follow up visit the patient mentioned pain in his foot which turned out to be a recent fracture of a metatarsal bone.
Alen = alendronate 70 mg once weekly, Iban = ibandronate 150 mg once monthly, Ris = risedronate 35 mg once weekly
P1NP = procollagen type 1 N-terminal propeptide; CTX = C-terminal crosslinking telopeptide; LSC = least significant change

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