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Kast S, Shojaa M, Kohl M, von Stengel S, Gosch M, Jakob F, Kerschan-Schindl K, Kladny B, Klöckner N, Lange U, Middeldorf S, Peters S, Schoene D, Sieber C, Thomasius F, Uder M, Kemmler W. Effects of different exercise intensity on bone mineral density in adults: a comparative systematic review and meta-analysis. Osteoporos Int 2022; 33:1643-1657. [PMID: 35304613 PMCID: PMC9499891 DOI: 10.1007/s00198-022-06329-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 01/31/2022] [Indexed: 10/25/2022]
Abstract
PURPOSE The primary objective of the present systematic review and meta-analysis was to determine the effect of differing exercise intensity on (areal) bone mineral density (BMD) at lumbar spine and hip in adults by a comparative meta-analysis. METHODS A systematic review of the literature according to the PRISMA statement included: (a) exercise trials, (b) with ≥two study arms that compared different exercise intensities, (c) intervention ≥6 months, (d) BMD assessments at lumbar spine (LS) or hip. Five electronic databases were scanned without language restrictions up to July 2021. The present analysis of exercise intensity was conducted as a mixed-effect meta-analysis and applied "type of exercise" and "study duration" as moderator in subgroup analyses. Outcome measures were standardized mean differences (SMD) for BMD changes at the LS, and hip. RESULTS Eleven exercise studies with 26 study arms were included. Although the effect of high-intensity exercise was more pronounced on LS-BMD (SMD: 0.19, 95%-CI: 0.61 to -0.23) and hip-ROI (0.17, 0.38 to -0.04), we did not observe significant differences between the groups (LS-BMD: p=0.373 and hip-BMD: p=0.109). We observed a substantial level of heterogeneity between the trials for LS- but not for hip-BMD. Applying "type of exercise" and "study duration" as moderators did not significantly modify the differences between low and high exercise intensity on BMD at LS or hip. CONCLUSION There is insufficient evidence for a superior effect of high-intensity exercise on areal BMD at lumbar spine and hip in people aged 50 years and older. Varying exercise intensity with periods of lower exercise intensity intermitted by higher intensity might be a promising option to address the issue of exercise intensities in intervention studies.
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Affiliation(s)
- S Kast
- Institute of Medical Physics, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
- Research and Writing Group on Austria/Germany/Suisse S3 Guideline "Exercise and Fracture Prevention", Bonn, Germany
| | - M Shojaa
- Institute of Medical Physics, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
- Research and Writing Group on Austria/Germany/Suisse S3 Guideline "Exercise and Fracture Prevention", Bonn, Germany
- Institute of Health Science, Department Population-Based Medicine, University Hospital Tübingen, Tübingen, Germany
| | - M Kohl
- Research and Writing Group on Austria/Germany/Suisse S3 Guideline "Exercise and Fracture Prevention", Bonn, Germany
- Department of Med. and Life Sciences, University of Furtwangen, Schwenningen, Germany
| | - S von Stengel
- Institute of Medical Physics, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
- Research and Writing Group on Austria/Germany/Suisse S3 Guideline "Exercise and Fracture Prevention", Bonn, Germany
| | - M Gosch
- Research and Writing Group on Austria/Germany/Suisse S3 Guideline "Exercise and Fracture Prevention", Bonn, Germany
- Paracelsus Medical University Nürnberg and General Hospital Nürnberg, Nürnberg, Germany
| | - F Jakob
- Research and Writing Group on Austria/Germany/Suisse S3 Guideline "Exercise and Fracture Prevention", Bonn, Germany
- Bernhard Heine Zentrum für Bewegungsforschung, University of Würzburg, Würzburg, Germany
| | - K Kerschan-Schindl
- Research and Writing Group on Austria/Germany/Suisse S3 Guideline "Exercise and Fracture Prevention", Bonn, Germany
- Austrian Society for Bone and Mineral Research, Vienna, Austria
| | - B Kladny
- Research and Writing Group on Austria/Germany/Suisse S3 Guideline "Exercise and Fracture Prevention", Bonn, Germany
- German Society for Orthopaedics and Trauma, Berlin, Germany
| | - N Klöckner
- Research and Writing Group on Austria/Germany/Suisse S3 Guideline "Exercise and Fracture Prevention", Bonn, Germany
- Deutsche Rheuma-Liga Bundesverband e.V., Bonn, Germany
| | - U Lange
- Research and Writing Group on Austria/Germany/Suisse S3 Guideline "Exercise and Fracture Prevention", Bonn, Germany
- German Society for Physical and Rehabilitative Medicine, Dresden, Germany
| | - S Middeldorf
- Research and Writing Group on Austria/Germany/Suisse S3 Guideline "Exercise and Fracture Prevention", Bonn, Germany
- International Musculoskeletal Pain Society, Berlin, Germany
| | - S Peters
- Research and Writing Group on Austria/Germany/Suisse S3 Guideline "Exercise and Fracture Prevention", Bonn, Germany
- German Association for Health-Related Fitness and Exercise Therapy, Hürth-Efferen, Germany
| | - D Schoene
- Institute of Medical Physics, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
- Research and Writing Group on Austria/Germany/Suisse S3 Guideline "Exercise and Fracture Prevention", Bonn, Germany
| | - C Sieber
- Research and Writing Group on Austria/Germany/Suisse S3 Guideline "Exercise and Fracture Prevention", Bonn, Germany
- European Geriatric Medicine Society (EuGMS), Institute for Biomedicine of Aging, FAU Erlangen-Nürnberg, Nürnberg, Germany
| | - F Thomasius
- Research and Writing Group on Austria/Germany/Suisse S3 Guideline "Exercise and Fracture Prevention", Bonn, Germany
- Osteology Umbrella Association Germany, Austria, Switzerland, Frankfurt, Germany
| | - M Uder
- Research and Writing Group on Austria/Germany/Suisse S3 Guideline "Exercise and Fracture Prevention", Bonn, Germany
- Institute of Radiology, FAU-Erlangen-Nürnberg and University Hospital Erlangen, Erlangen, Germany
| | - W Kemmler
- Institute of Medical Physics, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany.
- Research and Writing Group on Austria/Germany/Suisse S3 Guideline "Exercise and Fracture Prevention", Bonn, Germany.
- Institute of Radiology, FAU-Erlangen-Nürnberg and University Hospital Erlangen, Erlangen, Germany.
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Kyvernitakis I, Kostev K, Thomasius F, Stumpf U, Hadji P. Effect of progestogen-only contraception on premenopausal fracture risk: a case-control study. Osteoporos Int 2020; 31:1801-1806. [PMID: 32377808 DOI: 10.1007/s00198-020-05437-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 04/22/2020] [Indexed: 10/24/2022]
Abstract
UNLABELLED Our study demonstrated that progestogen-only oral and intrauterine contraceptives are not associated with fracture risk independent from age. PURPOSE The use of progestogen-only contraception, resulting in a hypoestrogenic state, has been associated with impaired bone acquisition and increased fracture risk. The aim of this large population-based study was to assess the fracture risk in association with the use of progestogen-only contraceptives (progestogen-only pills (POPs) and progestogen-containing IUDs (LNG-IUD)). METHODS We identified 14,421 women between 16 and 55 years of age with a first-time diagnosis of fracture and matched them with 14,421 random controls using the Disease Analyzer Database. RESULTS The results of the first adjusted logistic regression model (ever use vs. never use of progestogen-only contraceptives) revealed that there was no significant association between the use of POPs (OR = 0.98, 95% CI 0.90-1.07, p = 0.657) or LNG-IUDs (OR = 0.99, 95% CI 0.81-1.21, p = 0.945) and fracture incidence. Also, in the second regression model, we observed no effect of duration of use of POPs (OR = 1.01, 95% CI 0.98-1.03, p = 0.672) or LNG-IUDs (OR = 0.94, 95% CI 0.87-1.02, p = 0.177) on fracture occurrence. We also observed no effect in different age groups. CONCLUSION Our study results indicate that progestogen-only contraception (either POPs or LNG-IUPs) is not associated with fracture risk and may be considered a bone-safe option for adults and adolescents.
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Affiliation(s)
- I Kyvernitakis
- Department of Obstetrics and Prenatal Medicine, Asklepios Clinics Barmbek, Heidberg-Nord and Wandsbek, Hamburg, Germany.
- Department of Obstetrics and Prenatal Medicine, Asklepios Clinic Barmbek, Rübenkamp 220, 22307, Hamburg, Germany.
- Philipps University of Marburg, Marburg, Germany.
| | - K Kostev
- Department of Epidemiology,, IQVIA, Frankfurt, Germany
| | - F Thomasius
- Frankfurt Center of Bone Health, Frankfurt, Germany
| | - U Stumpf
- Department of General, Trauma, and Reconstructive Surgery, Munich University Hospital LMU, Munich, Germany
| | - P Hadji
- Philipps University of Marburg, Marburg, Germany
- Frankfurt Center of Bone Health, Frankfurt, Germany
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Thomasius F, Baum E, Bernecker P, Böcker W, Brabant T, Clarenz P, Demary W, Dimai HP, Engelbrecht M, Engelke K, Fratermann U, Grieser T, Gulich M, Hadji P, Henning J, Jehle PM, Kern PM, Ketteler M, Klatt G, Kraenzlin M, Maus U, Meier C, Moser U, Müller D, Peichl P, Pfeifer M, Rintelen B, Rueger JM, Schober HC, Schöffel D, Schwarz H, Siggelkow H, Suhm N, Wiese KG, Wörtler K, Kurth AA. DVO Leitlinie 2017 zur Prophylaxe, Diagnostik und Therapie der Osteoporose bei postmenopausalen Frauen und Männern. ACTA ACUST UNITED AC 2018. [DOI: 10.1055/s-0038-1673537] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
ZusammenfassungDiese DVO Leitlinien, die in erster Linie für Allgemeinmediziner und Spezialisten für Knochenerkrankungen bestimmt sind, sollten von allen im klinischen und ambulanten Bereich tätigen medizinischen Fachkräften angewendet werden. Ziel der Leitlinie ist die Verbesserung der Diagnose, Prävention und Behandlung von Osteoporose und der Folgen der Erkrankung auf der Grundlage evidenzbasierter Medizin.Klare Empfehlungen, welche Patienten zu diagnostizieren und behandeln sind (basierend auf Risikofaktoren [einschließlich sekundärer Osteoporose]) sowie Primär-, Sekundär- oder Tertiärprävention werden dargestellt, mit dem Schwerpunkt auf der postmenopausalen Osteoporose und der Osteoporose bei Männern.Die Identifizierung von Patienten mit einem hohen Risiko für Frakturen wird hervorgehoben, und spezifische Schwellenwerte für die Intervention sind definiert (20 % Hüftfrakturrisiko innerhalb von 10 Jahren diagnostischer Schwellenwert, 30 % Hüftfrakturrisiko innerhalb von 10 Jahren therapeutische Schwelle). Die Diagnose von Osteoporose basiert auf der Anamnese des Patienten, der körperlichen Untersuchung, dem Funktionstest (z. B. Timed Up and Go Test), konventionellen Röntgenaufnahmen der Brust- und Lendenwirbelsäule und der Bestimmung der Knochenmineraldichte (BMD) durch das DXA Verfahren.Die Anamnese ist entscheidend für die Abschätzung des Frakturrisikos auf der Grundlage von 40 wissenschaftlich überprüften Risikofaktoren, die das Frakturrisiko mindestens verdoppeln (z. B. Begleiterkrankungen, Hüftfrakturen in der Familie, prävalente Frakturen an jedem Ort, Lebensstil, Anwendung von Medikamenten, körperliche Aktivität und Stürze). Röntgenaufnahmen der Brust- und Lendenwirbelsäule sind wichtig, um prävalente Wirbelkörperfrakturen zu erkennen. Beim Fehlen eines großen Traumas kann jede Fraktur bei Erwachsenen über dem Alter von 50 Jahren eine Diagnose von Osteoporose nahelegen, mit dem höchsten Risiko für eine nachfolgende Fraktur innerhalb einer kurzen Zeit nach der ersten Fraktur. BMD-Messungen mit DXA sind wichtig, um das individuelle Frakturrisiko besser abschätzen zu können. Eine grundlegende Laboruntersuchung ist obligatorisch, um verschiedene Formen der sekundären Osteoporose ausschließen zu können.Der DVO-Patientenfindungs-Algorithmus basiert auf dem Geschlecht, Alter, Knochenmineraldichte und vorbestehenden Frakturen als wichtigste Informationen. Die Indikation für eine aktive anti-osteoporotische Therapie kann durch multiple Risikofaktoren modifiziert und verfeinert werden. Dieser Algorithmus wurde seit dem Richtlinien-Update 2006 verwendet und wurde entsprechend der internationalen Literatur zu Risikofaktoren für Osteoporose und osteoporotische Frakturen aktualisiert und angepasst.Die Behandlung der Osteoporose enthält viele Therapiepfeiler. Zusammen mit Empfehlungen für Bewegung, Physiotherapie und Sturzprävention sowie Ernährung (z. B. Calcium, Vit. D), werden pharmakologische Behandlungen basierend auf evidenzbasierter Medizin empfohlen. Die aktiven Anti-Osteoporose-Medikamente müssen für die Indikation postmenopausale Osteoporose und männliche Osteoporose in Deutschland, Österreich und der Schweiz zugelassen sein. Das Management und die Vorbeugung von häufigen oder seltenen Nebenwirkungen aufgrund von Anti-Osteoporose-Behandlungen, die in der klinischen Praxis angewendet werden, werden ebenfalls detailliert behandelt.
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Kyvernitakis I, Kostev K, Nassour T, Thomasius F, Hadji P. The impact of depot medroxyprogesterone acetate on fracture risk: a case-control study from the UK. Osteoporos Int 2017; 28:291-297. [PMID: 27461017 DOI: 10.1007/s00198-016-3714-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 07/19/2016] [Indexed: 11/30/2022]
Abstract
UNLABELLED There has been concerning about women receiving depot medroxyprogesterone acetate (DMPA) contraception because of the prolonged hypoestrogenemic state regarding the potential negative effects on bone health. This study showed that DMPA exposure is associated with increased fracture risk and that fracture risk increases with longer DMPA exposure. INTRODUCTION DMPA has been associated with impaired bone mineral acquisition during adolescence and accelerated bone loss in later life. We performed this large population-based study to assess the association between use of DMPA or combined oral contraceptives and the incident risk of fracture. METHODS We identified 4189 women between 20 and 44 years of age with a first-time fracture diagnosis, matched them with 4189 random controls using the Disease Analyzer database and investigated the relation with DMPA exposure. RESULTS Overall, 11 % of the fracture cases and 7.7 % of the controls had DMPA use recorded. The adjusted OR for developing a fracture in patients with current use of DMPA compared to non-users was 0.97 (95 % CI 0.51-1.86), 2.41 (95 % CI 1.42-4.08), and 1.46 (95 % CI 0.96-2.23) for 1-2, 3-9, and ≥10 prescriptions, respectively. The adjusted OR for developing a fracture in patients with past use of DMPA compared to non-users was 0.96 (95 % CI 0.73-1.26), 1.14 (95 % CI 0.86-1.51), and 1.55 (95 % CI 1.07-2.27) for 1-2, 3-9, and ≥10 prescriptions, respectively. The highest fracture risk was identified in young patients less than 30 years with longer DMPA exposure (≥10 prescriptions; OR 3.04, 95 % CI 1.36-6.81), as well as in patients in the late reproductive years with past use of DMPA (OR 1.72, 95 % CI 1.13-2.63). CONCLUSIONS Our results indicate that DMPA exposure is associated with increased fracture risk and may have negative effects on bone metabolism, resulting in impaired bone mineral acquisition during adolescence and accelerated bone loss in adult life.
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Affiliation(s)
- I Kyvernitakis
- Department of Obstetrics and Gynecology, Bürgerhospital Frankfurt, Goethe-University of Frankfurt, Nibelungenallee 37-41, 60318, Frankfurt am Main, Germany.
- Faculty of Medicine, Philipps-University of Marburg, Marburg, Germany.
| | - K Kostev
- IMS HEALTH GmbH & Co. OHG, Epidemiology, Real World Evidence Solutions, Darmstädter Landstraße 108, 60598, Frankfurt, Germany
| | - T Nassour
- Faculty of Medicine, Philipps-University of Marburg, Marburg, Germany
| | - F Thomasius
- Department of Bone Oncology, Gyn. Endocrinology and Reproductive Medicine, Nordwest Hospital, Goethe-University of Frankfurt, Frankfurt a.M., Germany
| | - P Hadji
- Department of Bone Oncology, Gyn. Endocrinology and Reproductive Medicine, Nordwest Hospital, Goethe-University of Frankfurt, Frankfurt a.M., Germany
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Hadji P, Kyvernitakis I, Kann PH, Niedhart C, Hofbauer LC, Schwarz H, Kurth AA, Thomasius F, Schulte M, Intorcia M, Psachoulia E, Schmid T. GRAND-4: the German retrospective analysis of long-term persistence in women with osteoporosis treated with bisphosphonates or denosumab. Osteoporos Int 2016; 27:2967-78. [PMID: 27172934 PMCID: PMC5042990 DOI: 10.1007/s00198-016-3623-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 04/28/2016] [Indexed: 11/02/2022]
Abstract
UNLABELLED This retrospective database study assessed 2-year persistence with bisphosphonates or denosumab in a large German cohort of women with a first-time prescription for osteoporosis treatment. Compared with intravenous or oral bisphosphonates, 2-year persistence was 1.5-2 times higher and risk of discontinuation was significantly lower (P < 0.0001) with denosumab. INTRODUCTION Persistence with osteoporosis therapies is critical for fracture risk reduction. Detailed data on long-term persistence (≥2 years) with bisphosphonates and denosumab are sparse. METHODS From the German IMS® database, we included women aged 40 years or older with a first-time prescription for bisphosphonates or denosumab between July 2010 and August 2014; patients were followed up until December 2014. The main outcome was treatment discontinuation, with a 60-day permissible gap between filled prescriptions. Two-year persistence was estimated using Kaplan-Meier survival curves, with treatment discontinuation as the failure event. Denosumab was compared with intravenous (i.v.) and oral bisphosphonates separately. Cox proportional hazard ratios (HRs) for the 2-year risk of discontinuation were calculated, with adjustment for age, physician specialty, health insurance status, and previous medication use. RESULTS Two-year persistence with denosumab was significantly higher than with i.v. or oral bisphosphonates (39.8 % [n = 21,154] vs 20.9 % [i.v. ibandronate; n = 20,472] and 24.8 % [i.v. zoledronic acid; n = 3966] and 16.7-17.5 % [oral bisphosphonates; n = 114,401]; all P < 0.001). Patients receiving i.v. ibandronate, i.v. zoledronic acid, or oral bisphosphonates had a significantly increased risk of treatment discontinuation than did those receiving denosumab (HR = 1.65, 1.28, and 1.96-2.02, respectively; all P < 0.0001). CONCLUSIONS Two-year persistence with denosumab was 1.5-2 times higher than with i.v. or oral bisphosphonates, and risk of discontinuation was significantly lower with denosumab than with bisphosphonates. A more detailed understanding of factors affecting medication-taking behavior may improve persistence and thereby reduce rates of fracture.
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Affiliation(s)
- P Hadji
- Department of Bone Oncology, Endocrinology, and Reproductive Medicine, Krankenhaus Nordwest, Steinbacher Hohl 2-26, 60488, Frankfurt am Main, Germany.
| | - I Kyvernitakis
- Department of Bone Oncology, Gynecological Endocrinology and Reproductive Medicine, Nordwest Hospital, Frankfurt am Main, Germany
| | - P H Kann
- Centre for Internal Medicine - Endocrinology & Diabetes, Philipps University of Marburg, Marburg, Germany
| | | | - L C Hofbauer
- Division of Endocrinology, Diabetes, and Bone Diseases, Department of Medicine 3 and Center for Healthy Aging, TU Dresden Medical Center, Dresden, Germany
| | - H Schwarz
- Facharztpraxis für Orthopädie und Physiotherapie, Freudenstadt, Germany
| | - A A Kurth
- Themistocles Gluck Hospital, Ratingen, Germany
| | - F Thomasius
- Department of Bone Oncology and Osteoporosis Center, Krankenhaus Nordwest, Frankfurt am Main, Germany
| | - M Schulte
- Amgen (Europe) GmbH, Munich, Germany
| | | | | | - T Schmid
- Amgen (Europe) GmbH, Munich, Germany
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Farahmand P, Marin F, Hawkins F, Möricke R, Ringe JD, Glüer CC, Papaioannou N, Minisola S, Martínez G, Nolla JM, Niedhart C, Guañabens N, Nuti R, Martín-Mola E, Thomasius F, Peña J, Graeff C, Kapetanos G, Petto H, Gentzel A, Reisinger A, Zysset PK. Early changes in biochemical markers of bone formation during teriparatide therapy correlate with improvements in vertebral strength in men with glucocorticoid-induced osteoporosis. Osteoporos Int 2013; 24:2971-81. [PMID: 23740422 PMCID: PMC3838582 DOI: 10.1007/s00198-013-2379-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 04/23/2013] [Indexed: 01/19/2023]
Abstract
UNLABELLED Changes of the bone formation marker PINP correlated positively with improvements in vertebral strength in men with glucocorticoid-induced osteoporosis (GIO) who received 18-month treatment with teriparatide, but not with risedronate. These results support the use of PINP as a surrogate marker of bone strength in GIO patients treated with teriparatide. INTRODUCTION To investigate the correlations between biochemical markers of bone turnover and vertebral strength estimated by finite element analysis (FEA) in men with GIO. METHODS A total of 92 men with GIO were included in an 18-month, randomized, open-label trial of teriparatide (20 μg/day, n = 45) and risedronate (35 mg/week, n = 47). High-resolution quantitative computed tomography images of the 12th thoracic vertebra obtained at baseline, 6 and 18 months were converted into digital nonlinear FE models and subjected to anterior bending, axial compression and torsion. Stiffness and strength were computed for each model and loading mode. Serum biochemical markers of bone formation (amino-terminal-propeptide of type I collagen [PINP]) and bone resorption (type I collagen cross-linked C-telopeptide degradation fragments [CTx]) were measured at baseline, 3 months, 6 months and 18 months. A mixed-model of repeated measures analysed changes from baseline and between-group differences. Spearman correlations assessed the relationship between changes from baseline of bone markers with FEA variables. RESULTS PINP and CTx levels increased in the teriparatide group and decreased in the risedronate group. FEA-derived parameters increased in both groups, but were significantly higher at 18 months in the teriparatide group. Significant positive correlations were found between changes from baseline of PINP at 3, 6 and 18 months with changes in FE strength in the teriparatide-treated group, but not in the risedronate group. CONCLUSIONS Positive correlations between changes in a biochemical marker of bone formation and improvement of biomechanical properties support the use of PINP as a surrogate marker of bone strength in teriparatide-treated GIO patients.
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Affiliation(s)
- P Farahmand
- West German Osteoporosis Centre, Klinikum Leverkusen, University of Cologne, Am Gesundheitspark 11, 51375, Leverkusen, Germany,
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