Ebina Kosuke, Kobayakawa Tomonori, Etani Yuki, Noguchi Takaaki, Kashii Masafumi, Okamura Gensuke, Nagayama Yoshio, Tsuboi Hideki, Miyama Akira, Hirao Makoto, Fukuda Yuji, Kurihara Takuya, Sugimoto Atsushi, Nakata Ken, Okada Seiji
Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan; Department of Sports Medical Biomechanics, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan.
Kobayakawa Orthopaedic and Rheumatologic Clinic, 1969 Kunou, Fukuroi, Shizuoka 437-0061, Japan.
Bone. 2025 Apr;193:117389. doi: 10.1016/j.bone.2025.117389. Epub 2025 Jan 4.
To evaluate the impact of prior teriparatide (TPTD) treatment on the effectiveness of romosozumab (ROMO) in postmenopausal osteoporosis.
In this retrospective, case-controlled, multicenter study, 323 postmenopausal patients were initiated ROMO. Of these, 275 were treatment-naïve, and 48 were switched from TPTD, with uninterrupted ROMO treatment for 12 months. Propensity score matching was applied to ensure clinical comparability, yielding 44 patients in each group. Baseline characteristics included a mean age of 78.0 years, lumbar spine (LS) T-score of -3.6, and total hip (TH) T-score of -2.8. Bone mineral density (BMD) and serum bone turnover markers were evaluated over the 12-month period.
The increasing rate in the bone formation marker PINP was significantly greater in the treatment-naïve group compared to the TPTD-switched group throughout the 1-12 month period. Conversely, the reduction in the bone resorption marker TRACP-5b was similar between the groups, indicating a diminished anabolic window in the TPTD-switched group. After 12 months, the TPTD-switched group showed lower BMD gains in the LS (10.3 % vs. 17.3 %; P = 0.002) and TH (3.1 % vs. 7.8 %; P = 0.002) compared to the treatment-naïve group. Multiple regression analysis revealed positive associations between the 12-month percentage BMD increases (LS; β = 0.30; 95 % CI = 0.85-11.61; P = 0.024 / TH; β = 0.32; 95 % CI = 0.51-8.56; P = 0.028) and being treatment-naïve compared to prior TPTD treatment.
Prior TPTD treatment may attenuate the effectiveness of ROMO, potentially due to diminished bone formation activation.
评估既往使用特立帕肽（TPTD）治疗对罗莫单抗（ROMO）治疗绝经后骨质疏松症疗效的影响。
在这项回顾性、病例对照、多中心研究中，323例绝经后患者开始使用ROMO治疗。其中，275例为初治患者，48例由TPTD转换而来，均接受了12个月不间断的ROMO治疗。应用倾向得分匹配法以确保临床可比性，每组各有44例患者。基线特征包括平均年龄78.0岁，腰椎（LS）T值为-3.6，全髋（TH）T值为-2.8。在12个月期间评估骨密度（BMD）和血清骨转换标志物。
在1至12个月期间，初治组骨形成标志物PINP的升高率显著高于TPTD转换组。相反，两组间骨吸收标志物TRACP-5b的降低情况相似，表明TPTD转换组的合成代谢窗口期缩短。12个月后，与初治组相比，TPTD转换组的腰椎BMD增加幅度较低（10.3%对17.3%；P = 0.002），全髋BMD增加幅度也较低（3.1%对7.8%；P = 0.002）。多元回归分析显示，与既往TPTD治疗相比，初治状态与12个月时BMD增加百分比呈正相关（腰椎；β = 0.30；95%CI = 0.85 - 11.61；P = 0.024 / 全髋；β = 0.32；95%CI = 0.51 - 8.56；P = 0.028）。
既往TPTD治疗可能会减弱ROMO的疗效，这可能是由于骨形成激活减弱所致。
