Giveon Sharon, Zacay Galia, Vered Iris, Foldes A Joseph, Tripto-Shkolnik Liana
Division of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Sheba Road 2, Ramat Gan, Tel Hashomer 5262100, Israel.
School of Medicine, Tel Aviv University, Israel.
Ther Adv Endocrinol Metab. 2023 Nov 22;14:20420188231213639. doi: 10.1177/20420188231213639. eCollection 2023.
Teriparatide (TPTD) should be followed by an antiresorptive to maximize bone mineral density gain and anti-fracture protection. Infrequent zoledronic acid (ZOL) administration has demonstrated effectiveness. The duration of ZOL effect following TPTD is unknown.
To evaluate the effect of ZOL on bone resorption marker in a post-TPTD ZOL-alone scenario in osteoporotic patients.
Retrospective cohort study.
Patients treated with TPTD followed by ZOL (TPTD-ZOL) or with a single ZOL infusion were identified in the database of a tertiary referral center. Clinical and laboratory data, including C-terminal telopeptide of type I collagen (CTX) following ZOL treatment, were compared.
Twenty-six patients (93% women) treated with TPTD-ZOL and 41 with ZOL were comparable in age (median 70.1 69.6 years, = 0.6) and sex. Timing of CTX measurement post-ZOL was the same, median 1.0 year. CTX was lower following TPTD-ZOL (median 142.1 184.2 pg/mL, = 0.005). In a multivariable regression model (controlled for baseline characteristics), pretreatment with TPTD strongly predicted CTX <150 pg/mL, 1 year following ZOL (odds ratio = 7.5, 95% CI 1.3-58.1, = 0.03). In a subgroup with sequential CTX measurements following one ZOL, significantly lower levels persisted in the TPTD-ZOL group for a median of 4.4 years follow-up.
ZOL-administered sequential to TPTD yielded deeper and more prolonged bone resorption suppression than ZOL alone. Prospective data are needed to confirm whether in a sequential treatment scenario, subsequent ZOL dosing interval should be less frequent.
特立帕肽（TPTD）治疗后应联合使用抗骨吸收药物，以最大程度提高骨密度并增强抗骨折保护作用。不频繁使用唑来膦酸（ZOL）已证明有效。TPTD治疗后ZOL的作用持续时间尚不清楚。
评估在骨质疏松症患者中，仅使用ZOL的TPTD治疗后方案中ZOL对骨吸收标志物的影响。
回顾性队列研究。
在一家三级转诊中心的数据库中，识别出接受TPTD后再接受ZOL治疗（TPTD-ZOL）或单次输注ZOL治疗的患者。比较临床和实验室数据，包括ZOL治疗后的I型胶原C末端肽（CTX）。
26例接受TPTD-ZOL治疗的患者（93%为女性）和41例接受ZOL治疗的患者在年龄（中位数70.1对69.6岁，P = 0.6）和性别方面具有可比性。ZOL治疗后CTX测量的时间相同，中位数为1.0年。TPTD-ZOL治疗后的CTX较低（中位数142.1对184.2 pg/mL，P = 0.005）。在多变量回归模型（根据基线特征进行校正）中，TPTD预处理强烈预测ZOL治疗1年后CTX<150 pg/mL（比值比= 7.5，95%CI 1.3 - 58.1，P = 0.03）。在一组接受一次ZOL治疗后进行连续CTX测量的亚组中，TPTD-ZOL组中较低水平持续存在，中位随访时间为4.4年。
TPTD后给予ZOL比单独使用ZOL能产生更深且更持久的骨吸收抑制作用。需要前瞻性数据来证实，在序贯治疗方案中，后续ZOL给药间隔是否应延长。
