Guyer Laura, Lehmann Oliver, Wenger Mathias, Oser Sven, Studer Ueli, Steiner Christian, Ziswiler Hans-Rudolf, Schmid Gernot, Häuselmann HansJörg, Reichenbach Stephan, Lehmann Thomas, Everts-Graber Judith
Faculty of Medicine, University of Bern, Bern, Switzerland.
ETH Zürich, Department of Information Technology and Electrical Engineering, Zürich, Switzerland.
Bone. 2025 Jun;195:117445. doi: 10.1016/j.bone.2025.117445. Epub 2025 Mar 5.
Teriparatide followed by antiresorptive therapy exhibits fracture reduction efficacy for up to 2 years, but it remains unclear if this leads to sustained increases in bone mineral density (BMD) and trabecular bone score (TBS), and if BMD correlates with fracture risk reduction.
In this multicenter cohort study, the effect of teriparatide administration for 18-24 months, followed by antiresorptive therapy, was assessed in patients partipicipating in a nationwide Swiss osteoporosis registry. BMD and TBS were measured up to 10 years before and after teriparatide initiation.
A total of 624 patients (87 % female, age 67 ± 13 years) were enrolled from May 2004 to December 2023. Among them, 198 (32 %) received no treatment prior to teriparatide, while 426 had received previous antiresorptive therapies (median duration 5.9 years [2.2, 8.0]). All patients underwent subsequent antiresorptive therapy, mainly with bisphosphonates and denosumab. The incidences of vertebral, hip, and any fractures were 0.96, 0.11, and 1.37, respectively, within 2 years prior to teriparatide initiation. The total hip T-score did not correlate with fracture reduction under teriparatide. After transitioning from teriparatide to an antiresorptive regimen, fracture incidence remained low and BMD was significantly higher for up to 5 years after teriparatide compared to the pre-treatment period (T-score + 0.876 for lumbar spine, p < 0.001; and + 0.112 for total hip, p < 0.005), while TBS increased by 0.047 (p < 0.001). Overall, significant improvement was observed in pretreated and treatment-naïve patients undergoing teriparatide treatment.
Teriparatide led to sustained lower incidences of vertebral, hip, and other fractures for up to 8 years after switching to antiresorptive agents in both pretreated and treatment-naïve patients. Additionally, BMD and TBS levels were significantly higher than those before teriparatide treatment. During teriparatide treatment, the total hip T-score did not correlate with fracture risk.
特立帕肽序贯抗吸收治疗在长达2年的时间内显示出降低骨折的疗效，但目前尚不清楚这是否会导致骨矿物质密度（BMD）和骨小梁骨评分（TBS）持续增加，以及BMD是否与骨折风险降低相关。
在这项多中心队列研究中，对参与瑞士全国骨质疏松症登记处的患者评估了18 - 24个月的特立帕肽给药，随后进行抗吸收治疗的效果。在特立帕肽开始治疗前10年及之后测量BMD和TBS。
2004年5月至2023年12月共纳入624例患者（87%为女性，年龄67±13岁）。其中，198例（32%）在使用特立帕肽之前未接受过治疗，而426例曾接受过抗吸收治疗（中位持续时间5.9年[2.2, 8.0]）。所有患者随后均接受抗吸收治疗，主要使用双膦酸盐和地诺单抗。在开始使用特立帕肽前2年内，椎体、髋部和任何骨折的发生率分别为0.96、0.11和1.37。在特立帕肽治疗期间，全髋T值与骨折减少无关。从特立帕肽转换为抗吸收治疗方案后，骨折发生率仍然较低，与治疗前相比，特立帕肽治疗后长达5年的BMD显著更高（腰椎T值增加0.876，p < 0.001；全髋增加0.112，p < 0.005），而TBS增加了0.047（p < 0.001）。总体而言，接受特立帕肽治疗的既往治疗患者和初治患者均观察到显著改善。
在既往治疗患者和初治患者中，特立帕肽在转换为抗吸收药物后长达8年的时间里，导致椎体、髋部和其他骨折的发生率持续降低。此外，BMD和TBS水平显著高于特立帕肽治疗前。在特立帕肽治疗期间，全髋T值与骨折风险无关。
