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Background <p>Postmenopausal osteoporosis (PMOP) elevates fracture risk. Zoledronic acid effectively reduces fractures, but individual bone mineral density (BMD) responses vary. Systematic evidence on independent site-specific predictors of BMD changes across femoral neck, total hip, and lumbar spine remains scarce. This study aimed to identify independent factors associated with 12-month BMD changes at the femoral neck (ΔFNBMD), total hip (ΔTHBMD), and lumbar spine (ΔLSBMD) in PMOP patients (T-score ≤ − 2.5) following initial zoledronic acid treatment.</p> Methods <p>A single-center retrospective cohort of 145 PMOP patients (BMD T-score ≤–2.5) was analyzed. Baseline BMD, bone turnover markers (β-cross-linked C-terminal telopeptide of type I collagen [β-CTX-I], N-terminal propeptide of type I procollagen [PINP]), blood biochemistry, and body mass index (BMI) were assessed. BMD was reassessed at the 12-month follow-up. Multiple regression and logistic models identified predictors of ΔFNBMD, ΔTHBMD, and ΔLSBMD. Receiver operating characteristic (ROC) analysis evaluated predictive performance.</p> Results <p>ΔFNBMD correlated independently with baseline β-CTX-I (β = 0.031, <i>P</i> = 0.017). ΔTHBMD was associated with β-CTX-I (β = 0.036, <i>P</i> &lt; 0.001) and BMI (β = 0.001, <i>P</i> = 0.027). ΔLSBMD linked to PINP (β = 0.000, <i>P</i> = 0.009), serum iron (β = 0.003, <i>P</i> = 0.023), and chloride (β=-0.005, <i>P</i> = 0.023). Logistic regression showed higher baseline PINP increased the odds of effective FNBMD improvement (odds ratio [OR] = 1.042 per 1 ng/mL increase, 95% confidence interval [CI]: 1.018–1.067, <i>P</i> &lt; 0.001), while β-CTX-I (OR = 1.003, <i>P</i> = 0.008) and BMI (OR = 1.156, <i>P</i> = 0.023) influenced THBMD response. ROC analysis confirmed PINP as a robust predictor for FNBMD efficacy (area under the curve [AUC] = 0.724, <i>P</i> &lt; 0.001), and β-CTX-I (AUC = 0.669, <i>P</i> = 0.004) and BMI (AUC = 0.637, <i>P</i> = 0.021) as clinically actionable predictors for THBMD efficacy.</p> Conclusion <p>Zoledronic acid-induced BMD changes in PMOP exhibit site-specific associations with distinct biomarkers and clinical parameters. These findings provide preliminary evidence for tailoring treatment based on baseline metabolic and anthropometric profiles, though larger prospective studies are required to validate these markers for clinical application.</p>

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Site-specific predictors of bone mineral density response to zoledronic acid in postmenopausal osteoporosis: differential roles of bone turnover markers and body mass index across skeletal sites

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月10日

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  • Chunyan Xu,
  • Yaqin Xu,
  • Pingda Bian

摘要

Background

Postmenopausal osteoporosis (PMOP) elevates fracture risk. Zoledronic acid effectively reduces fractures, but individual bone mineral density (BMD) responses vary. Systematic evidence on independent site-specific predictors of BMD changes across femoral neck, total hip, and lumbar spine remains scarce. This study aimed to identify independent factors associated with 12-month BMD changes at the femoral neck (ΔFNBMD), total hip (ΔTHBMD), and lumbar spine (ΔLSBMD) in PMOP patients (T-score ≤ − 2.5) following initial zoledronic acid treatment.

Methods

A single-center retrospective cohort of 145 PMOP patients (BMD T-score ≤–2.5) was analyzed. Baseline BMD, bone turnover markers (β-cross-linked C-terminal telopeptide of type I collagen [β-CTX-I], N-terminal propeptide of type I procollagen [PINP]), blood biochemistry, and body mass index (BMI) were assessed. BMD was reassessed at the 12-month follow-up. Multiple regression and logistic models identified predictors of ΔFNBMD, ΔTHBMD, and ΔLSBMD. Receiver operating characteristic (ROC) analysis evaluated predictive performance.

Results

ΔFNBMD correlated independently with baseline β-CTX-I (β = 0.031, P = 0.017). ΔTHBMD was associated with β-CTX-I (β = 0.036, P < 0.001) and BMI (β = 0.001, P = 0.027). ΔLSBMD linked to PINP (β = 0.000, P = 0.009), serum iron (β = 0.003, P = 0.023), and chloride (β=-0.005, P = 0.023). Logistic regression showed higher baseline PINP increased the odds of effective FNBMD improvement (odds ratio [OR] = 1.042 per 1 ng/mL increase, 95% confidence interval [CI]: 1.018–1.067, P < 0.001), while β-CTX-I (OR = 1.003, P = 0.008) and BMI (OR = 1.156, P = 0.023) influenced THBMD response. ROC analysis confirmed PINP as a robust predictor for FNBMD efficacy (area under the curve [AUC] = 0.724, P < 0.001), and β-CTX-I (AUC = 0.669, P = 0.004) and BMI (AUC = 0.637, P = 0.021) as clinically actionable predictors for THBMD efficacy.

Conclusion

Zoledronic acid-induced BMD changes in PMOP exhibit site-specific associations with distinct biomarkers and clinical parameters. These findings provide preliminary evidence for tailoring treatment based on baseline metabolic and anthropometric profiles, though larger prospective studies are required to validate these markers for clinical application.