每日特立帕肽(20μg)(D-PTH)的影响,每周大剂量特立帕肽(56.5μg)(W-PTH),或双膦酸盐(BPs)对区域骨矿物质密度(aBMD),骨转换标志物(BTMs),体积BMD(vBMD),微体系结构,并对绝经后骨质疏松症患者的估计强度进行了调查。
这项研究的参与者是131名具有脆性骨折病史的女性。他们随机接受D-PTH,W-PTH,或BP(阿仑膦酸盐或利塞膦酸盐)持续18个月。双能X射线吸收法(DXA),BTMs,在基线和治疗6个月和18个月后评估高分辨率外周定量CT(HR-pQCT)参数.主要终点是皮质厚度的变化(%)(Ct。Th)治疗18个月后与基线相比。
DXA显示D-PTH,W-PTH,和BP增加腰椎aBMD(+12.0%,+8.5%,和+6.8%)和总髋关节aBMD(+3.0%,+2.1%,和+3.0%),但D-PTH和W-PTH降低了1/3半径aBMD(-4.1%,-3.0%,-1.4%)18个月后。在HR-pQCT上,D-PTH增加小梁vBMD(Tb。vBMD)在18个月后桡骨远端和胫骨(+6.4%,+3.7%)与BP组相比,皮质体积组织矿物质密度降低(Ct。vTMD)(-1.8%,-0.9%)与其他组相比,增加CT。Th(+1.3%,+3.9%),并增加了失效载荷(FL)(+4.7%,+4.4%)。W-PTH增加Tb。vBMD(+5.3%,+1.9%),保持CT。vTMD(-0.7%,+0.2%)与D-PTH相比,增加CT。Th(+0.6%,+3.6%),并增加FL(+4.9%,+4.5%)。BP增加了Tb。vBMD仅在半径内(+2.0%,+0.2%),保持CT。vTMD(-0.6%,+0.3%),增加CT。Th(+0.5%,+3.4%),并增加FL(+3.9%,+2.8%)。
D-PTH和W-PTH相对增加Ct。Th,主端点。D-PTH对小梁骨具有强烈作用。尽管D-PTH降低了Ct。vTMD,它增加了CT。Th和总骨强度。W-PTH对小梁骨有中等影响,保持CT。vTMD,增加CT。Th和总骨强度与D-PTH相同。
The effects of daily teriparatide (20 μg) (D-PTH), weekly high-dose teriparatide (56.5 μg) (W-PTH), or bisphosphonates (BPs) on areal bone mineral density (aBMD), bone turnover markers (BTMs), volumetric BMD (vBMD), microarchitecture, and estimated strength were investigated in postmenopausal osteoporosis patients.
The study participants were 131 women with a history of fragility fractures. They were randomized to receive D-PTH, W-PTH, or BPs (alendronate or risedronate) for 18 months. Dual-energy X-ray absorptiometry (DXA), BTMs, and high-resolution peripheral quantitative CT (HR-pQCT) parameters were evaluated at baseline and after 6 and 18 months of treatment. The primary endpoint was the change (%) in cortical thickness (Ct.Th) after 18 months\' treatment compared with baseline.
DXA showed that D-PTH, W-PTH, and BPs increased lumbar spine aBMD (+12.0%, +8.5%, and +6.8%) and total hip aBMD (+3.0%, +2.1%, and +3.0%), but D-PTH and W-PTH decreased 1/3 radius aBMD (-4.1%, -3.0%, -1.4%) after 18 months. On HR-pQCT, D-PTH increased trabecular vBMD (Tb.vBMD) at the distal radius and tibia after 18 months (+6.4%, +3.7%) compared with the BPs group, decreased cortical volumetric tissue mineral density (Ct.vTMD) (-1.8%, -0.9%) compared with the other groups, increased Ct.Th (+1.3%, +3.9%), and increased failure load (FL) (+4.7%, +4.4%). W-PTH increased Tb.vBMD (+5.3%, +1.9%), maintained Ct.vTMD (-0.7%, +0.2%) compared with D-PTH, increased Ct.Th (+0.6%, +3.6%), and increased FL (+4.9%, +4.5%). The BPs increased Tb.vBMD only in the radius (+2.0%, +0.2%), maintained Ct.vTMD (-0.6%, +0.3%), increased Ct.Th (+0.5%, +3.4%), and increased FL (+3.9%, +2.8%).
D-PTH and W-PTH comparably increased Ct.Th, the primary endpoint. D-PTH had a strong effect on trabecular bone. Although D-PTH decreased Ct.vTMD, it increased Ct.Th and total bone strength. W-PTH had a moderate effect on trabecular bone, maintained Ct.vTMD, and increased Ct.Th and total bone strength to the same extent as D-PTH.