Stepan J J, Burr D B, Li J, Ma Y L, Petto H, Sipos A, Dobnig H, Fahrleitner-Pammer A, Michalská D, Pavo I
Institute of Rheumatology, Faculty of Medicine, Charles University, Na Slupi 4, CZ12850, Prague, Czech Republic.
Osteoporos Int. 2010 Dec;21(12):2027-36. doi: 10.1007/s00198-009-1168-7. Epub 2010 Feb 5.
The level of increased bone formation after 24 months of treatment with teriparatide (rhPTH (1-34), TPTD) is similar in patients who were either treatment-naïve (TN) or had lower bone turnover initially due to previous alendronate (ALN) therapy.
Bone anabolic effects of TPTD in postmenopausal women with osteoporosis may be blunted during the initial phase after switching from ALN to TPTD. To explore the long-term implications, we examined histomorphometric and biochemical markers of bone turnover of patients on TPTD therapy after long-term ALN treatment.
Paired biopsies were obtained after tetracycline double labeling at baseline and after 24 months of TPTD treatment from 29 ALN-pretreated (64.5 ± 16.4 months) and 16 TN patients. Biochemical markers were measured at baseline, during the treatment, or at study end.
Compared with the baseline, after 24-month TPTD, activation frequency (Ac.F.) and osteoid surface (OS) increased in both groups: 0.11-0.34 cycles per year, 3.96-9.8% in the ALN-pretreated group and 0.19-0.33 cycles per year, 6.2-11.3% (p < 0.05) in the TN group, respectively. Biochemical and histomorphometric markers correlated positively both at baseline and endpoint. Serum amino terminal propeptide of type I procollagen (PINP) correlated with Ac.F. (r = 0.57, p < 0.001 and r = 0.48, p < 0.01) and OS (r = 0.51, p < 0.01 and r = 0.56, p < 0.01) at baseline and endpoint, respectively. Following 3 months of treatment, increases in biochemical markers like PINP predicted the increase in Ac.F. (r = 0.52, p < 0.01) and OS (r = 0.54, p < 0.01) after 24 months.
The increased level of formation is similar in patients who were either TN or had lower bone turnover initially due to previous ALN therapy. Elevated bone formation in postmenopausal women with osteoporosis was sustained over a 24-month period by TPTD. Biochemical markers of bone formation are a good surrogate for the assessment of TPTD effects.
对于既往未接受过治疗（TN）或因先前使用阿仑膦酸盐（ALN）治疗而初始骨转换较低的患者，使用特立帕肽（rhPTH(1 - 34)，TPTD）治疗24个月后骨形成增加的水平相似。
在从ALN转换至TPTD后的初始阶段，TPTD对绝经后骨质疏松症女性的骨合成代谢作用可能会减弱。为了探究其长期影响，我们检查了长期接受ALN治疗后接受TPTD治疗患者的骨转换组织形态计量学和生化标志物。
对29例接受过ALN预处理（64.5±16.4个月）的患者和16例TN患者在基线期进行四环素双重标记后以及TPTD治疗24个月后获取配对活检样本。在基线期、治疗期间或研究结束时测量生化标志物。
与基线相比，TPTD治疗24个月后，两组的激活频率（Ac.F.）和类骨质表面（OS）均增加：接受过ALN预处理的组中每年0.11 - 0.34个周期，3.96 - 9.8%，TN组中每年0.19 - 0.33个周期，6.2 - 11.3%（p < 0.05）。生化和组织形态计量学标志物在基线期和终点均呈正相关。血清I型前胶原氨基端前肽（PINP）在基线期和终点分别与Ac.F.（r = 0.57，p < 0.001和r = 0.48，p < 0.01）以及OS（r = 0.51，p < 0.
