Anastasilakis A D, Polyzos S A, Avramidis A, Papatheodorou A, Terpos E
Department of Endocrinology, 424 Military Hospital, Thessaloniki, Greece.
Horm Metab Res. 2009 Jul;41(7):559-62. doi: 10.1055/s-0029-1192035. Epub 2009 Feb 9.
Teriparatide (TPTD - recombinant human parathyroid hormone 1-34) markedly increases bone mineral density (BMD) and reduces fracture risk. Sequential treatment with an antiresorptive agent is believed to preserve or further increase BMD. Strontium ranelate (SR) is thought to uncouple bone remodeling resulting in increased BMD and reduced fracture risk. We aimed to evaluate the effect of SR on BMD in women with established osteoporosis previously treated with TPTD. Nineteen out of the consecutive 23 initially recruited postmenopausal Caucasian women (aged 65.9+/-1.8 years) with established osteoporosis completed treatment with TPTD, 20 microg daily for 18 months, followed by SR 2 g daily for 12 months. Lumbar spine BMD was measured by dual-energy X-ray absorptiometry (DXA) pre- and post-TPTD administration, as well as twelve months post-SR administration. Blood samples for bone-specific alkaline phosphatase (BSAP) and C-terminal telopeptide of type 1 collagen (CTx) were obtained at the same time points. Lumbar spine BMD increased significantly after 18 months of TPTD (p<0.001) and further improved with sequential SR treatment (p=0.033). Serum BSAP and CTx increased significantly with TPTD (p=0.008 and 0.017, respectively) and reduced to baseline levels after SR treatment (p=0.031 and 0.019, respectively). The change in BSAP was positively correlated with the change in CTx during both TPTD (r=0.641, p=0.007) and SR treatment (r=0.539, p=0.026). In conclusion, our data suggest that SR following TPTD administration further increases BMD and could represent an effective sequential treatment.
特立帕肽（TPTD - 重组人甲状旁腺激素1 - 34）可显著增加骨矿物质密度（BMD）并降低骨折风险。人们认为，序贯使用抗吸收剂可维持或进一步增加骨密度。雷奈酸锶（SR）被认为可使骨重塑解偶联，从而增加骨密度并降低骨折风险。我们旨在评估SR对先前接受TPTD治疗的已确诊骨质疏松症女性骨密度的影响。最初招募的23名绝经后白种人女性（年龄65.9±1.8岁）患有已确诊的骨质疏松症，其中19名完成了TPTD治疗，每天20微克，共18个月，随后接受SR治疗，每天2克，共12个月。在TPTD给药前后以及SR给药12个月后，采用双能X线吸收法（DXA）测量腰椎骨密度。在相同时间点采集血液样本检测骨特异性碱性磷酸酶（BSAP）和I型胶原C末端肽（CTx）。TPTD治疗18个月后腰椎骨密度显著增加（p<0.001），序贯SR治疗后进一步改善（p = 0.033）。血清BSAP和CTx在TPTD治疗时显著升高（分别为p = 0.008和0.017），SR治疗后降至基线水平（分别为p = 0.031和0.019）。在TPTD治疗期间（r = 0.641，p = 0.007）和SR治疗期间（r = 0.539，p = 0.026），BSAP的变化与CTx的变化呈正相关。总之，我们的数据表明，TPTD给药后使用SR可进一步增加骨密度，可能是一种有效的序贯治疗方法。
