Division of Endocrinology, Department of Internal Medicine, Pusan National University, Busan, Korea,
Calcif Tissue Int. 2014 Feb;94(2):159-68. doi: 10.1007/s00223-013-9772-0. Epub 2013 Aug 2.
Intermittent parathyroid hormone (PTH) administration has a potent ability to increase bone mass, regardless of underlying conditions or species. A recent study using LDLR(-/-) mice showed that the anabolic effect of PTH was blunted by hyperlipidemia, whereas PTH anabolism was rescued by enhancement of high-density lipoprotein cholesterol (HDL-C) function. We conducted a retrospective longitudinal study to determine whether lipid profiles also affect the anabolic effect of intermittent PTH treatment in humans. Fifty-two patients (8 males and 44 females, ages 38-85 years) with severe osteoporosis who had been treated with teriparatide (TPTD, recombinant human PTH(1-34) for 12 months were studied at Severance Hospital, Yonsei University. C-telopeptide (CTX) and osteocalcin (OCN) were measured at 0, 3, and 12 months; and total cholesterol, triglycerides, and HDL-C were measured at baseline. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry at 0 and 12 months. Lumbar spine BMD increased significantly after 12 months of treatment with TPTD (10.0 ± 9.3%, p < 0.001). Initial 3-month changes in CTX and OCN levels revealed positive correlations with the increase in lumbar BMD (r = 0.546, p = 0.001 and r = 0.500, p = 0.006, respectively). Moreover, percentage change in lumbar BMD at 12 months showed a negative correlation with baseline total cholesterol (r = -0.438, p = 0.009) and a positive correlation with HDL-C (r = 0.498, p = 0.016). A smaller 3-month increase in OCN and a lower HDL-C level at baseline were associated with a smaller lumbar BMD increase after TPTD treatment, even after adjustment for age, sex, and other confounding factors (β = 0.462, p = 0.031 for ΔOCN and β = 0.670, p = 0.004 for HDL-C). Plasma levels of lipids, especially HDL-C, seem to be associated with the extent of osteoanabolic effects of TPTD in humans.
间歇性甲状旁腺激素（PTH）给药具有增加骨量的强大能力，无论潜在条件或物种如何。最近一项使用 LDLR(-/-) 小鼠的研究表明，PTH 的合成代谢作用被高脂血症削弱，而高密度脂蛋白胆固醇（HDL-C）功能增强则挽救了 PTH 的合成代谢作用。我们进行了一项回顾性纵向研究，以确定脂质谱是否也会影响间歇性 PTH 治疗在人类中的合成代谢作用。52 名患有严重骨质疏松症的患者（8 名男性和 44 名女性，年龄 38-85 岁）在延世大学塞弗伦斯医院接受特立帕肽（TPTD，重组人 PTH(1-34)治疗 12 个月。在 0、3 和 12 个月时测量 C 端肽（CTX）和骨钙素（OCN）；并在基线时测量总胆固醇、甘油三酯和 HDL-C。在 0 和 12 个月时通过双能 X 射线吸收法测量骨矿物质密度（BMD）。TPTD 治疗 12 个月后，腰椎 BMD 显著增加（10.0±9.3%，p<0.001）。CTX 和 OCN 水平的初始 3 个月变化与腰椎 BMD 的增加呈正相关（r=0.546，p=0.001 和 r=0.500，p=0.006）。此外，12 个月时腰椎 BMD 的百分比变化与基线总胆固醇呈负相关（r=-0.438，p=0.009），与 HDL-C 呈正相关（r=0.498，p=0.016）。TPTD 治疗后，腰椎 BMD 增加较少，与基线时 OCN 增加较小和 HDL-C 水平较低有关，即使在调整年龄、性别和其他混杂因素后（ΔOCN 的β=0.462，p=0.031，HDL-C 的β=0.670，p=0.004）。血脂水平，尤其是 HDL-C，似乎与特立帕肽在人类中的骨合成代谢作用的程度有关。
