Lane N E, Sanchez S, Modin G W, Genant H K, Pierini E, Arnaud C D
Department of Medicine, University of California at San Francisco, San Francisco, California 94143, USA.
J Clin Invest. 1998 Oct 15;102(8):1627-33. doi: 10.1172/JCI3914.
Corticosteroid-induced osteoporosis is the most common secondary cause of osteoporosis. We conducted a 12-mo, randomized clinical trial of human parathyroid hormone 1-34 (hPTH 1-34) in postmenopausal women (mean age was 63 yr) with osteoporosis who were taking corticosteroids and hormone replacement therapy. Response to the treatment was assessed with bone mineral density (BMD) measurements of the lumbar spine by quantitative computed tomography (QCT); BMD measurements of the lumbar spine, hip, and forearm by dual-energy x-ray absorptiometry (DXA); and biochemical markers of bone turnover. The mean (+/-SE) changes in BMD of the lumbar spine by QCT and DXA in the PTH group were 35+/-5.5% and 11+/-1.4%, respectively, compared with a relatively small change of 1.7+/-1.8% and 0+/-0.9% in the estrogen-only group. The differences in mean percentage between the groups at 1 yr were 33.5% for the lumbar spine by QCT (P < 0.001) and 9.8% for the lumbar spine by DXA (P < 0.001). The changes in the hip and forearm were not significantly different between or within the groups. During the first 3 mo of PTH treatment, markers of bone formation increased to nearly 150%, whereas markers of bone resorption increased only 100%, suggesting an early uncoupling of bone turnover in favor of formation. These results suggest that parathyroid hormone dramatically increases bone mass in the central skeleton of postmenopausal women with corticosteroid- induced osteoporosis who are taking hormone replacement.
糖皮质激素诱导的骨质疏松症是骨质疏松症最常见的继发性病因。我们对正在服用糖皮质激素和激素替代疗法的绝经后骨质疏松症女性（平均年龄63岁）进行了一项为期12个月的人甲状旁腺激素1-34（hPTH 1-34）随机临床试验。通过定量计算机断层扫描（QCT）测量腰椎骨密度（BMD）、通过双能X线吸收法（DXA）测量腰椎、髋部和前臂的BMD以及骨转换生化标志物来评估治疗反应。PTH组通过QCT和DXA测量的腰椎BMD平均（±SE）变化分别为35±5.5%和11±1.4%，而仅用雌激素组的变化相对较小，分别为1.7±1.8%和0±0.9%。1年时两组之间腰椎QCT测量的平均百分比差异为33.5%（P<0.001），腰椎DXA测量的为9.8%（P<0.001）。髋部和前臂的变化在组间或组内无显著差异。在PTH治疗的前3个月，骨形成标志物增加至近150%，而骨吸收标志物仅增加100%，这表明骨转换早期解偶联有利于骨形成。这些结果表明，甲状旁腺激素可显著增加正在服用激素替代疗法的糖皮质激素诱导的骨质疏松症绝经后女性中轴骨骼的骨量。
