目的:每日特立帕肽(D-PTH,20μg/天),每周大剂量特立帕肽(W-PTH,56.5μg/周),使用定量计算机断层扫描(QCT)研究椎骨和股骨近端的双膦酸盐(BP)。
方法:共有131名有脆性骨折史的绝经后妇女随机接受D-PTH,W-PTH,或双膦酸盐(口服阿仑膦酸盐或利塞膦酸盐)。在基线和治疗18个月后评估QCT。
结果:共有86名参与者通过QCT进行了评估(脊柱:D-PTH:25,W-PTH:21,BP:29。髋关节:PTH:22,W-PTH:21,BP:32。退学率:30.5%)。椎骨的QCT显示D-PTH,W-PTH,和BP增加了总vBMD(+34.8%,+18.2%,+11.1%),小梁vBMD(+50.8%,+20.8%,+12.2%),和边际vBMD(+20.0%,+14.0%,+11.5%)。D-PTH组小梁vBMD的增加大于W-PTH和BP组。股骨近端QCT显示D-PTH,W-PTH,和BP增加了总vBMD(+2.8%,+3.6%,+3.2%)和小梁vBMD(+7.7%,+5.1%,+3.4%),而只有W-PTH和BP显着增加皮质vBMD(-0.1%,+1.5%,+1.6%)。尽管D-PTH组的皮质vBMD没有显着增加,皮质骨体积(BV)在所有三个治疗组中增加(2.1%,+3.6%,+3.1%)。
结论:D-PTH对椎骨骨小梁有很强的作用。尽管D-PTH没有增加股骨近端皮质BMD,它增加了皮质BV。W-PTH对椎骨骨小梁有中等影响,同时增加股骨近端皮质BMD和BV。尽管与特立帕肽相比,BP对椎骨骨小梁的影响有限,它增加了股骨近端皮质BMD和BV。
OBJECTIVE: The effects of daily teriparatide (D-PTH, 20 μg/day), weekly high-dose teriparatide (W-PTH, 56.5 μg/week), or bisphosphonate (BP) on the vertebra and proximal femur were investigated using quantitative computed tomography (QCT).
METHODS: A total of 131 postmenopausal women with a history of fragility fractures were randomized to receive D-PTH, W-PTH, or bisphosphonate (oral alendronate or risedronate). QCT were evaluated at baseline and after 18 months of treatment.
RESULTS: A total of 86 participants were evaluated by QCT (Spine: D-PTH: 25, W-PTH: 21, BP: 29. Hip: PTH: 22, W-PTH: 21, BP: 32. Dropout rate: 30.5 %). QCT of the vertebra showed that D-PTH, W-PTH, and BP increased total vBMD (+34.8 %, +18.2 %, +11.1 %), trabecular vBMD (+50.8 %, +20.8 %, +12.2 %), and marginal vBMD (+20.0 %, +14.0 %, +11.5 %). The increase in trabecular vBMD was greater in the D-PTH group than in the W-PTH and BP groups. QCT of the proximal femur showed that D-PTH, W-PTH, and BP increased total vBMD (+2.8 %, +3.6 %, +3.2 %) and trabecular vBMD (+7.7 %, +5.1 %, +3.4 %), while only W-PTH and BP significantly increased cortical vBMD (-0.1 %, +1.5 %, +1.6 %). Although there was no significant increase in cortical vBMD in the D-PTH group, cortical bone volume (BV) increased in all three treatment groups (+2.1 %, +3.6 %, +3.1 %).
CONCLUSIONS: D-PTH had a strong effect on trabecular bone of vertebra. Although D-PTH did not increase cortical BMD of proximal femur, it increased cortical BV. W-PTH had a moderate effect on trabecular bone of vertebra, while it increased both cortical BMD and BV of proximal femur. Although BP had a limited effect on trabecular bone of vertebra compared to teriparatide, it increased both cortical BMD and BV of proximal femur.