Department of Endocrinology, Odense University Hospital, Odense, Denmark.
J Bone Miner Res. 2013 Apr;28(4):736-45. doi: 10.1002/jbmr.1784.
Whereas the beneficial effects of intermittent treatment with parathyroid hormone (PTH) (intact PTH 1-84 or fragment PTH 1-34, teriparatide) on vertebral strength is well documented, treatment may not be equally effective in the peripheral skeleton. We used high-resolution peripheral quantitative computed tomography (HR-pQCT) to detail effects on compartmental geometry, density, and microarchitecture as well as finite element (FE) estimated integral strength at the distal radius and tibia in postmenopausal osteoporotic women treated with PTH 1-34 (20 µg sc daily, n = 18) or PTH 1-84 (100 µg sc daily, n = 20) for 18 months in an open-label, nonrandomized study. A group of postmenopausal osteoporotic women receiving zoledronic acid (5 mg infusion once yearly, n = 33) was also included. Anabolic therapy increased cortical porosity in radius (PTH 1-34 32 ± 37%, PTH 1-84 39 ± 32%, both p < 0.001) and tibia (PTH 1-34 13 ± 27%, PTH 1-84 15 ± 22%, both p < 0.001) with corresponding declines in cortical density. With PTH 1-34, increases in cortical thickness in radius (2.0 ± 3.8%, p < 0.05) and tibia (3.8 ± 10.4%, p < 0.01) were found. Trabecular number increased in tibia with both PTH 1-34 (4.2 ± 7.1%, p < 0.05) and PTH 1-84 (5.3 ± 8.3%, p < 0.01). Zoledronic acid did not impact cortical porosity at either site but increased cortical thickness (3.0 ± 3.5%, p < 0.01), total (2.7 ± 2.5%, p < 0.001) and cortical density (1.5 ± 2.0%, p < 0.01) in tibia as well as trabecular volume fraction in radius (2.5 ± 5.1%, p < 0.05) and tibia (2.2 ± 2.2%, p < 0.01). FE estimated bone strength was preserved, but not increased, with PTH 1-34 and zoledronic acid at both sites, whereas it decreased with PTH 1-84 in radius (-2.8 ± 5.8%, p < 0.05) and tibia (-3.9 ± 4.8%, p < 0.001). Conclusively, divergent treatment-specific effects in cortical and trabecular bone were observed with anabolic and zoledronic acid therapy. The finding of decreased estimated strength with PTH 1-84 treatment was surprising and warrants confirmation.
虽然甲状旁腺激素（PTH）（完整的 PTH 1-84 或片段 PTH 1-34，特立帕肽）间歇性治疗对椎体强度的有益影响已有充分记录，但治疗在周围骨骼中可能并非同样有效。我们使用高分辨率外周定量计算机断层扫描（HR-pQCT）详细描述了在接受甲状旁腺素 1-34（每天 20μg sc，n=18）或甲状旁腺素 1-84（每天 100μg sc，n=20）治疗 18 个月后，绝经后骨质疏松症女性的容积骨密度、微结构以及有限元（FE）估计的桡骨和胫骨整体强度的变化。一项包括接受唑来膦酸（每年 5mg 输注一次，n=33）治疗的绝经后骨质疏松症女性的研究也包括在内。合成代谢治疗增加了桡骨（PTH 1-34 32±37%，PTH 1-84 39±32%，均 p<0.001）和胫骨（PTH 1-34 13±27%，PTH 1-84 15±22%，均 p<0.001）的皮质骨孔隙率，相应地降低了皮质骨密度。用 PTH 1-34 治疗后，发现桡骨（2.0±3.8%，p<0.05）和胫骨（3.8±10.4%，p<0.01）的皮质厚度增加。胫骨的小梁数量增加，这两种药物（PTH 1-34：4.2±7.1%，p<0.05；PTH 1-84：5.3±8.3%，p<0.01）。唑来膦酸治疗对两个部位的皮质骨孔隙率均无影响，但增加了胫骨的皮质厚度（3.0±3.5%，p<0.01）、总骨密度（2.7±2.5%，p<0.001）和皮质骨密度（1.5±2.0%，p<0.01），以及桡骨（2.5±5.1%，p<0.05）和胫骨（2.2±2.2%，p<0.01）的小梁体积分数。用 PTH 1-34 和唑来膦酸治疗后，桡骨和胫骨的 FE 估计骨强度保持不变，但没有增加，而用 PTH 1-84 治疗后则降低（桡骨：-2.8±5.8%，p<0.05；胫骨：-3.9±4.8%，p<0.001）。总之，我们观察到合成代谢和唑来膦酸治疗对皮质骨和小梁骨有不同的特异性治疗作用。用 PTH 1-84 治疗后估计强度降低的发现令人惊讶，需要进一步证实。
