Suk Kyung Soo, Lee Hwan Mo, Moon Seong-Hwan, Kim Hee June, Kim Hak Sun, Park Jin-Oh, Lee Byung Ho
Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea.
Department of Orthopaedic Surgery, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea.
Yonsei Med J. 2014 Nov;55(6):1576-83. doi: 10.3349/ymj.2014.55.6.1576.
Teriparatide markedly increases bone formation and strength, while reducing the incidence of new-onset osteoporotic vertebral compression fractures (OVCFs). In some countries, expenses for teriparatide use are covered by medical insurance for up to 6 months; however, the national medical insurance of the authors' country does not cover these expenses. This retrospective cohort study compared the therapeutic effects of teriparatide on the initial onset of a new OVCF after treatment of osteoporosis and/or related OVCFs with regard to therapeutic durations of longer than 3 months (LT3M) or shorter than 3 months (ST3M).
From May 2007 to February 2012, 404 patients who were prescribed and administered teriparatide and who could be followed-up for longer than 12 months were enrolled. They were divided into two groups depending on teriparatide duration: LT3M (n=132) and ST3M (n=272).
The group with the teriparatide duration of LT3M showed significantly less development of an initial OVCF within 1 year (p=0.004, chi-square). Duration of teriparatide use, body mass index, pre-teriparatide lowest spinal bone mineral density, and severity of osteoporosis significantly affected multiple regression analysis results (p<0.05). Survival analysis of first new-onset OVCFs demonstrated a significantly better survival rate for the LT3M group (log rank, p=0.005). Also, the ST3M group showed a higher odds ratio of 54.00 for development of an initial OVCF during follow-up than the LT3M group (Mantel-Haenzel common odds ratio, p=0.006).
At least one cyclic teriparatide administration is recommended to provide a protective effect against the initial onset of a new OVCF for up to one year after therapy.
特立帕肽可显著增加骨形成和骨强度，同时降低新发骨质疏松性椎体压缩骨折（OVCF）的发生率。在一些国家，特立帕肽的使用费用医保可报销长达6个月；然而，作者所在国家的国家医疗保险不涵盖这些费用。这项回顾性队列研究比较了特立帕肽治疗骨质疏松症和/或相关OVCF后，治疗时长超过3个月（LT3M）或短于3个月（ST3M）时，对新发生OVCF初始发作的治疗效果。
纳入2007年5月至2012年2月期间，404例开具并使用特立帕肽且随访时间超过12个月的患者。根据特立帕肽使用时长将他们分为两组：LT3M组（n = 132）和ST3M组（n = 272）。
特立帕肽使用时长为LT3M的组在1年内初始OVCF的发生明显较少（p = 0.004，卡方检验）。特立帕肽使用时长、体重指数、使用特立帕肽前最低腰椎骨密度和骨质疏松严重程度对多元回归分析结果有显著影响（p < 0.05）。首次新发OVCF的生存分析显示，LT3M组的生存率显著更高（对数秩检验，p = 0.005）。此外，ST3M组在随访期间初始OVCF发生的优势比为54.00，高于LT3M组（曼特尔 - 亨泽尔共同优势比，p = 0.006）。
建议至少进行一个周期的特立帕肽给药，以在治疗后长达一年的时间内，对新发生OVCF的初始发作提供保护作用。
