Anna Gosset, Anne-Lise Farcy, Clémence Dufond, Jean-Michel Pouillès, Florence Trémollieres
Menopause Center, Paule de Viguier Hospital, 330 Avenue de Grande-Bretagne, TSA 70034, Toulouse Cedex 9, 31059, Toulouse, France.
J Bone Miner Metab. 2023 Mar;41(2):278-285. doi: 10.1007/s00774-023-01412-3. Epub 2023 Mar 9.
To investigate the factors associated with changes in vertebral bone mineral density during teriparatide treatment.
Single centre, longitudinal study involving 145 osteoporotic postmenopausal women treated with teriparatide. Clinical evaluation, bone mineral density (BMD) measurements assessment and laboratory analyses were performed at baseline then after 12 and 18 months of treatment. Bone non-response to treatment was defined as no significant increase in BMD at 18 months as compared to baseline.
Of the 145 women initially included, 109 completed the 18-month course of the treatment. 75% of them had a history of prior osteoporotic treatment. Baseline mean age was 60 ± 8 years. Mean baseline vertebral T-score was - 3.7 ± 0.7 and 83 (76%) women had suffered at least one vertebral fracture. At the end of treatment, 18 women (17%) were classified as non-responders. In the responder group (n = 91), vertebral BMD increased by 0.091 ± 0.04 g/cm (12.2 ± 5.3%). Clinical characteristics, baseline BMDs and the percentage of women previously treated with bisphosphonates as well as the duration of prior treatment did not significantly differ between the two groups of responders and non-responders. At baseline, non-responders had significant mean lower C-terminal fragment of type 1 collagen (CTX) values than responders (p < 0.01). Only baseline CTX values (r = 0.30 p < 0.01) were independently correlated to vertebral BMD changes during teriparatide treatment.
A minority of treated women had no vertebral densitometric gain after 18 months of teriparatide therapy. Low levels of baseline bone remodeling were the main factor associated with poor response to treatment.
研究特立帕肽治疗期间与椎骨骨密度变化相关的因素。
单中心纵向研究，纳入145例接受特立帕肽治疗的绝经后骨质疏松妇女。在基线时、治疗12个月和18个月后进行临床评估、骨密度（BMD）测量评估及实验室分析。治疗无反应定义为与基线相比，18个月时BMD无显著增加。
最初纳入的145例妇女中，109例完成了18个月的治疗疗程。其中75%有既往骨质疏松治疗史。基线平均年龄为60±8岁。基线时平均椎体T值为-3.7±0.7，83例（76%）妇女曾发生至少一次椎体骨折。治疗结束时，18例妇女（17%）被归类为无反应者。在有反应组（n = 91）中，椎体BMD增加了0.091±0.04 g/cm（12.2±5.3%）。有反应者和无反应者两组在临床特征、基线BMD、既往接受双膦酸盐治疗的妇女百分比以及既往治疗持续时间方面无显著差异。基线时，无反应者的1型胶原C末端片段（CTX）平均水平显著低于有反应者（p < 0.01）。仅基线CTX值（r = 0.30，p < 0.01）与特立帕肽治疗期间椎体BMD变化独立相关。
少数接受治疗的妇女在特立帕肽治疗18个月后椎体骨密度未增加。基线骨重塑水平低是治疗反应不佳的主要相关因素。
