特立帕肽与阿仑膦酸钠治疗骨质疏松症：骨转换生化标志物、骨密度和生活质量的变化。

Teriparatide vs. alendronate as a treatment for osteoporosis: changes in biochemical markers of bone turnover, BMD and quality of life.

机构信息

Department of Molecular and Clinical Endocrinology and Oncology, University Federico II, Naples, Italy.

出版信息

Med Sci Monit. 2011 Aug;17(8):CR442-448. doi: 10.12659/msm.881905.

BACKGROUND

We studied the use of teriparatide in postmenopausal women with severe osteoporosis.

MATERIAL/METHODS: Two groups (A and B) of patients affected by severe osteoporosis (T-score ≤-2.5 at bone mineral density were analyzed and 2 vertebral fractures on radiograph). Group A was treated for 18 months with 20 µg/day of teriparatide. Group B was treated with bisphosphonates 70 mg/week. Every woman assumed 1 g of calcium and 800 IU of vitamin D3 daily. We evaluated the effects of therapy after 18 months (T18) from the beginning with bone turnover markers (alkaline phosphatase, procollagen type 1 N-terminal propeptide, and N-telopeptide cross-links) and dual-energy X-ray absorptiometry.

RESULTS

Group A, at T18 procollagen type 1 N-terminal propeptide levels, increased 127%; bone alkaline phosphatase levels increased to 65%; N-telopeptide cross-links levels increased to 110%. Group B, at T18 procollagen type 1 N-terminal propeptide levels, decreased to 74%; bone alkaline phosphatase levels decreased to 41%; N-telopeptide cross-links levels decreased to 72%. After 18 months, lumbar bone mineral density increased to 12.4% and femoral bone mineral density increased to 5.2% in group A. Group B lumbar bone mineral density increased to 3.85% and femoral bone mineral density increased to 1.99%. Only a new vertebral fracture occurred in group A (2.4%), whereas 6 fractures occurred in group B (15.7%). The quality of life questionnaire of the European Foundation for Osteoporosis (QUALEFFO) revealed a significant improvement in daily living, performed domestic jobs, and locomotor function in groups A and B.

CONCLUSIONS

The use of rhPTH in patients with severe osteoporosis offers more protection against fractures and improves the QoL more than bisphosphonates.

背景

我们研究了特立帕肽在绝经后严重骨质疏松症患者中的应用。

材料/方法：对两组（A 组和 B 组）患有严重骨质疏松症（骨密度 T 评分≤-2.5）且 X 光片显示有 2 处椎体骨折的患者进行分析。A 组接受为期 18 个月的特立帕肽 20μg/天治疗。B 组接受每周 70mg 双膦酸盐治疗。每位女性每天服用 1g 钙和 800IU 维生素 D3。我们在开始治疗后 18 个月（T18）评估了治疗效果，使用骨转换标志物（碱性磷酸酶、I 型前胶原 N 端前肽和 N 端肽交联）和双能 X 线吸收法进行评估。

结果

A 组在 T18 时 I 型前胶原 N 端前肽水平增加了 127%；骨碱性磷酸酶水平增加到 65%；N 端肽交联水平增加到 110%。B 组在 T18 时 I 型前胶原 N 端前肽水平下降到 74%；骨碱性磷酸酶水平下降到 41%；N 端肽交联水平下降到 72%。治疗 18 个月后，A 组腰椎骨密度增加了 12.4%，股骨骨密度增加了 5.2%；B 组腰椎骨密度增加了 3.85%，股骨骨密度增加了 1.99%。仅 A 组发生 1 例新的椎体骨折（2.4%），而 B 组发生 6 例骨折（15.7%）。欧洲骨质疏松症基金会生活质量问卷（QUALEFFO）显示，A 组和 B 组在日常生活、家务劳动和运动功能方面均有显著改善。