1
|
Kong M, Gao C, Luan X, Fan C, Hao M, Jin C, Zhao J, Li H, Zhao J, Luan J, Lin Y, Li Q. Analyzing the factors associated with efficacy among teriparatide treatment in postmenopausal women with osteoporosis. BMC Musculoskelet Disord 2024; 25:109. [PMID: 38310278 PMCID: PMC10837964 DOI: 10.1186/s12891-024-07227-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/23/2024] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND Teriparatide (TPTD) is a widely used anabolic agent for the treatment of osteoporosis. Several factors have been identified to be related to bone mineral density (BMD) increase in anti-osteoporosis treatment with other agents; however, there has been no systematic analysis to summarize the associated determinants of BMD reaction to daily teriparatide treatment. METHODS In this retrospective study, we performed a comprehensive investigation involving not only clinical data but also several relevant lifestyle factors to be examined for their potential contribution to BMD response. This post-hoc analysis included 258 post-menopaused patients with osteoporosis who received TPTD at 20 µg/day for 12 months. Univariate and multivariate analyses were conducted to distinguish the response variables of lumbar spine (LS) BMD transformation, the principal outcome measure of efficacy, from the baseline at 12 months. RESULTS Twelve months of TPTD treatment resulted in an absolute 0.39 ± 0.37 increase in T-score of LS BMD. Gastrointestinal disease, prior bisphosphonate or glucocorticoid treatment, no vitamin K2 supplementation, low levels of serum 25(OH)D and PINP, weak increment of PINP and β-CTX at 3 months, unhealthy lifestyle (excessive smoking, tea, coffee, and drinking), vegetarian diet pattern, low ALT level, and high BMD at baseline were determined by univariate analyses to be related to the weak reaction of TPTD treatment (P < 0.10). In the multiple regression model, postmenopausal women with vitamin K2 supplementation, higher baseline serum 25(OH)D level, and higher PINP concentration at 3 months indicated a good reaction of LS BMD at 12 months (P < 0.05). Patients with gastrointestinal disease, prior bisphosphonate and glucocorticoid treatment, vegetarian diet pattern, and higher baseline BMD were significantly more likely to have a lower absolute LS BMD response compared to patients without these characteristics (P < 0.05). Further analysis confirmed the negative effect of unhealthy lifestyle on TPTD treatment. CONCLUSION Our results emphasize the significance of a comprehensive assessment of clinical or lifestyle-related characteristics of postmenopausal women with osteoporosis in the management of TPTD therapy in routine care.
Collapse
Affiliation(s)
- Meng Kong
- Department of Spine Surgery, Qingdao Municipal Hospital, No. 5, Middle Dong Hai Road, Qing'dao, 266000, Shandong Province, China
| | - Changtong Gao
- Department of Oncology, Qingdao Municipal Hospital, No. 1, Jiao Zhou Road, Qing'dao, 266000, Shandong Province, China
| | - Xiaona Luan
- Department of Spine Surgery, Qingdao Municipal Hospital, No. 5, Middle Dong Hai Road, Qing'dao, 266000, Shandong Province, China
| | - Cuiying Fan
- Department of General Surgery, Ankang Hospital of Shandong Province, No. 1, Ji Dai Road, Ji'ning, 272000, Shandong Province, China
| | - Meng Hao
- Department of Spine Surgery, Qingdao Municipal Hospital, No. 5, Middle Dong Hai Road, Qing'dao, 266000, Shandong Province, China
| | - Canghai Jin
- Department of Spine Surgery, Qingdao Municipal Hospital, No. 5, Middle Dong Hai Road, Qing'dao, 266000, Shandong Province, China
| | - Jiangning Zhao
- Department of Spine Surgery, Qingdao Municipal Hospital, No. 5, Middle Dong Hai Road, Qing'dao, 266000, Shandong Province, China
| | - Hongyan Li
- Department of Spine Surgery, Qingdao Municipal Hospital, No. 5, Middle Dong Hai Road, Qing'dao, 266000, Shandong Province, China
| | - Jindong Zhao
- Department of Spine Surgery, Qingdao Municipal Hospital, No. 5, Middle Dong Hai Road, Qing'dao, 266000, Shandong Province, China
| | - Jian Luan
- Department of Spine Surgery, Qingdao Municipal Hospital, No. 5, Middle Dong Hai Road, Qing'dao, 266000, Shandong Province, China
| | - Yong Lin
- Department of Spine Surgery, Qingdao Municipal Hospital, No. 5, Middle Dong Hai Road, Qing'dao, 266000, Shandong Province, China.
| | - Qiang Li
- Department of Spine Surgery, Qingdao Municipal Hospital, No. 5, Middle Dong Hai Road, Qing'dao, 266000, Shandong Province, China.
| |
Collapse
|
2
|
Lee SY, Seo MS, Yoo JI. Effectiveness of Weekly Teriparatide Injection in Postmenopausal Patients with Hip Fractures. Clin Orthop Surg 2023; 15:552-559. [PMID: 37529188 PMCID: PMC10375812 DOI: 10.4055/cios22280] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 11/17/2022] [Accepted: 11/17/2022] [Indexed: 08/03/2023] Open
Abstract
Background Teriparatide is an effective anabolic agent used in the treatment of severe osteoporosis. In addition, it is also used to promote fracture healing. The purpose of this double-blind randomized controlled trial was to evaluate the influence of weekly teriparatide administration on bone formation in hip fracture patients. Methods The control group (n = 41) was composed of patients treated with normal saline other than teriparatide, and the teriparatide group (n = 51) consisted of patients who received weekly teriparatide. Bone turnover markers, C-terminal telopeptide (CTx) and osteocalcin (OC), were assessed through blood tests at the initial hospital visit and 3-month, 6-month, and 1-year follow-ups. Dual-energy X-ray absorptiometry was performed 5 days postoperatively and at 1-year postoperative follow-up. The degree of fracture union was evaluated by comparing the radiographic union scoring system for hips using Radiographic Union Score for Hip (RUSH) scores between the two groups at 3 months, 6 months, and 1 year after surgery. Results Evaluation of the rate of change in bone mineral density over 1 year showed that the lumber bone mineral density increased by more than 7% in the experimental group. The control group did not show a difference between the CTx and OC at 6 months, but the difference between the CTx and OC values was large at 6 months in the experimental group. The mean RUSH score was significantly different between the control group and the experimental group: 12.105 and 15.476, respectively (p = 0.004), at 3 months and 18.571 and 22.389, respectively, at 6 months (p = 0.006). Conclusions Weekly use of teriparatide improved fracture healing, bone formation, and clinical outcomes at 1 year after hip fracture surgery by the anabolic window effect.
Collapse
Affiliation(s)
- Sang Yeob Lee
- Biomedical Research Institute, Gyeongsang National University Hospital, Jinju, Korea
| | - Min-Seok Seo
- Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Jinju, Korea
| | - Jun-Il Yoo
- Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Jinju, Korea
| |
Collapse
|
3
|
Takada J, Yoshimura T, Uzawa T. Twice-weekly teriparatide improves lumbar spine BMD independent of pre-treatment BMD and bone turnover marker levels. J Bone Miner Metab 2021; 39:484-493. [PMID: 33389132 DOI: 10.1007/s00774-020-01186-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 11/19/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION There have been no reports of the effects of baseline lumbar spine bone mineral density (LS-BMD) and bone turnover marker levels on the therapeutic effect of a 28.2-μg teriparatide formulation for twice-weekly use (2/W-TPTD). MATERIALS AND METHODS An analysis was performed using data from a double-blind, randomized, non-inferiority trial (TWICE study) conducted with patients who received 2/W-TPTD or a 56.5-μg teriparatide formulation for once-weekly use (1/W-TPTD) for 48 weeks. The patients were divided into tertile groups based on baseline LS-BMD, urinary type I collagen cross-linked N-telopeptide (u-NTX), and serum type I procollagen-N-propeptide (P1NP) levels, respectively. Time profiles of these measurements were analyzed. Furthermore, whether a change in P1NP is a predictor for percentage change in BMD was assessed. RESULTS Across all tertile groups divided based on baseline LS-BMD and levels of bone turnover markers, the LS-BMD increased significantly. The u-NTX level decreased throughout the study period in the high- and middle-u-NTX-level groups. The P1NP level increased after 4 weeks, but subsequently decreased after 12 weeks and thereafter in the high-P1NP-level group; it increased after 4 weeks and subsequently fluctuated near the baseline level in the middle-P1NP-level group. A cut-off value of 12.0 µg/L for change in P1NP after 4 weeks of 2/W-TPTD as a predictor for percentage change in LS-BMD of 3% or more after 48 weeks gave a positive predictive value of 89.6%. CONCLUSION 2/W-TPTD, just like 1/W-TPTD, improved LS-BMD significantly, regardless of baseline LS-BMD and bone turnover marker levels.
Collapse
Affiliation(s)
- Junichi Takada
- Osteoporosis Center, Sapporo Kotoni Orthopaedics, 4-1-30 Kotoni-4-Jou, Sapporo, Hokkaido, Japan.
| | - Takeshi Yoshimura
- Medical Affairs Department, Asahi-Kasei Pharma Corporation, 1-1-2 Yurakucho, Chiyoda-ku, Tokyo, Japan
| | - Toyonobu Uzawa
- Medical Affairs Department, Asahi-Kasei Pharma Corporation, 1-1-2 Yurakucho, Chiyoda-ku, Tokyo, Japan
| |
Collapse
|