Telmisartan kullanımının kemik döngüsü belirteçleri üzerine etkileri

PPAR? agonisti olan tiazolidinedion grubu oral antidiyabetiklerin kemik metabolizmasina olumsuz etkiler gosterdigi bilinmektedir. Ancak PPAR? icin parsiyel agonist olan Ang II AT1 reseptor blokeri telmisartanin insanlarda kemik metabolizmasina etkisi bilinmemektedir. Insanlarda telmisartan kullaniminin kemik metabolizmasina net etkisinin hangi yonde olacaginin arastirilmasi amaclanmistir.Materyal-Metot: Telmisartan (N=24) veya losartan (N=21) kullanan hastalar calismaya dahil edildi. Bilinen kemik hastaligi olanlar, kemik metabolizmasini etkileyebilecek hastaligi veya ilac kullanimi olanlar calisma disi birakildi. Calisma baslangicinda ve ucuncu aydaki kontrol vizitlerinde serum Ca, P, 25 OHD, Ks.ALP, OC, IL-6 ve idrar NTx duzeyleri icin olcumler yapildi.Bulgular: Uc aylik izlemde Ca ve P'de anlamli degisim gorulmezken; 25 OHD [15.4 (10.2-41.9)'e karsin 17.8 (10.4-49.1) µg/mL, p=0.010] ve PTH (54.39±25.98'e karsin 45.12±22.87 pg/mL, p<0.001), Ks.ALP (16.51±5.02'ye karsilik 15.06±4.06 µg/L, p=0.008), OC (11.27±5.03'e karsilik 8.96±5.65 ng/mL, p=0.045), idrar NTx atilimi (96.37±64.51'e karsilik 43.08±35.68 nM BCE/mM, p<0.001), IL-6 [17.25 (2.30-196.9)'a karsilik 9.5 (0.8-137.6) pg/mL (p=0.002)] duzeyleri anlamli sekilde degisti. Ancak bu parametrelerdeki degisim acisindan gruplar arasinda fark yoktu. 25 OHD etkisini arindirmak amaciyla yapilan; kovaryant analizi sonrasi olculen parametrelerin hicbirinde anlamli degisim olmadigi goruldu ve parsiyel korelasyon analizinde NTx ve IL-6 arasinda pozitif bir korelasyon saptandi (R=0.338, p=0.033). PTH etkisi arindirildiktan sonra da parsiyel korelasyon analizinde NTx ve IL-6 arasindaki pozitif korelasyon devam etti (R=0.382, p=0.015).Sonuc: Insanlarda telmisartan kullanimi kemik metabolizmasini etkilememektedir. Calisma bulgulari D vitamini degisimiyle ilgilidir. AbstractIt is known that a group of oral hypoglycemic drugs, thiazolidinedions, are agonists for PPAR? receptors and have negative effects on bone metabolism. But the effect of telmisartan, which is a partially agonist for PPAR? and Ang II AT1 receptor blocker, on bone metabolism is not known.The aim of the study was to determine the net effect of telmisartan use on bone metabolism.Materials and Methods: The patients who use telmisartan (N=24) or losartan (N=21) were enrolled. The patients who have bone diseases, disease or drug use which can effect bone metabolism were excluded. Serum Ca, P, 25 OHD, BALP, OC, IL-6 and urinary NTx levels were measured at the start of study and third month visit.Findings: At the end of three months period there was no change for Ca and P. But the levels of 25 OHD [15.4 (10.2-41.9) vs 17.8 (10.4-49.1) µg/mL, p=0.010], PTH (54.39±25.98 vs 45.12±22.87 pg/mL, p<0.001), BALP (16.51±5.02 vs 15.06±4.06 µg/L, p=0.008), OC (11.27±5.03 vs 8.96±5.65 ng/mL, p=0.045), urinary NTx (96.37±64.51 vs 43.08±35.68 nM BCE/mM, p<0.001), IL-6 [17.25 (2.30-196.9) vs 9.5 (0.8-137.6) pg/mL (p=0.002)] were changed with statistical significance. But there was no differences in two groups about changes of these parameters. After the covariant analysis which was made for eliminate of 25 OHD effect; there was no significant change at each parameters and partial correlation analysis swohed a positive correlation between NTx and IL-6 (R=0.338, p=0.033). Arter the eliminatin of PTH effect the positive correlation of NTx between IL-6 was steady in partial correlation analysis (R=0.382, p=0.015).Conclusion: The use of telmisartn in humans does not effect the bone metabolism. Findings of the study are about the change of vitamin D.