Effects of Teriparatide Treatment and Discontinuation in Postmenopausal Women and Eugonadal Men with Osteoporosis
Effects of Teriparatide Treatment and Discontinuation in Postmenopausal Women and Eugonadal Men with Osteoporosis
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DOI：
10.1210/jc.2008-2630
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发表时间：
2009-08-01
影响因子：
5.8
通讯作者：
Finkelstein, Joel S.
中科院分区：
文献类型：
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作者：
Leder, Benjamin Z.;Neer, Robert M.;Finkelstein, Joel S.
背景：绝经后妇女停止特立帕肽治疗后，骨密度（BMD）下降。男性停止特立帕肽治疗后骨密度丢失的模式尚不清楚。目的：本研究的目的是确定绝经后女性和性腺正常男性之间特立帕肽诱导的骨增加和特立帕肽治疗后骨丢失的模式是否不同。设计：我们进行了一项前瞻性队列亚研究。患者：该研究包括14名绝经后女性和17名性腺正常男性，年龄46-85岁，腰椎或股骨颈BMD T评分低于-2。干预：特立帕（每天37微克皮下注射）给药24个月，然后停药12个月。我们用双能X线骨密度仪测量了不同解剖部位的BMD，用定量计算机断层扫描测量了骨小梁的BMD，和骨转换标志物。结果：在男性和女性的治疗期间，脊柱、股骨颈、全髋关节和骨小梁脊柱的BMD增加相似，而男性的桡骨BMD稳定，但女性的BMD下降了8.1 +/- 3.3%（P < 0.0001）。停止teriparbazole治疗后，女性后前脊柱BMD下降7.1 +/- 3.8%，男性下降4.1 +/- 3.5%（P = 0.036）。女性全髋和股骨颈的BMD分别下降了3.8 ± 3.9和3.1 ± 4.3%，但男性保持稳定（两个部位P < 0.05）。男性桡骨远端的BMD保持稳定，但女性增加了1.6 +/- 3.1%（P = 0.069）。结论：Teriparbazole似乎增加绝经后妇女和性腺功能正常的男性骨质疏松症的BMD相似。停止替普瑞酮后，女性BMD的下降幅度大于男性。如果在更大的队列中得到证实，这些结果将表明，特立帕林治疗后立即进行抗吸收治疗的适应症在男性中可能不像在女性中那样紧迫。（临床内分泌代谢杂志94：2915-2921，2009）
Context: In postmenopausal women, bone mineral density (BMD) declines after teriparatide therapy is stopped. The pattern of BMD loss after teriparatide therapy is stopped in men is less clear.Objective: The aim of the study was to determine whether the pattern of teriparatide-induced bone accrual and post-teriparatide bone loss differs between postmenopausal women and eugonadal men.Design: We conducted a prospective cohort substudy.Patients: The study included 14 postmenopausal women and 17 eugonadal men, ages 46-85 yr, with lumbar spine or femoral neck BMD T-scores below -2.Intervention: Teriparatide (37 mu g sc daily) was administered for 24 months, followed by 12 months off therapy.Main Outcome Measures: We measured BMD at various anatomic sites by dual-energy x-ray absorptiometry, trabecular spine BMD by quantitative computed tomography, and bone turnover markers during the treatment and observation periods. The response to teriparatide administration and discontinuation was compared between females and males.Results: BMD of the spine, femoral neck, total hip, and trabecular spine increased similarly during the treatment period in men and women, whereas BMD at the radius was stable in men but decreased by 8.1 +/- 3.3% in women (P < 0.0001). After teriparatide was stopped, BMD at the posterior-anterior spine decreased by 7.1 +/- 3.8% in women and by 4.1 +/- 3.5% in men (P = 0.036). BMD at the total hip and femoral neck decreased by 3.8 +/- 3.9 and 3.1 +/- 4.3%, respectively, in women but remained stable in men (P < 0.05 for both sites). BMD at the distal radius remained stable in men but increased in women by 1.6 +/- 3.1% (P = 0.069).Conclusions: Teriparatide appears to increase BMD similarly in postmenopausal women and eugonadal men with osteoporosis. After teriparatide is stopped, the decline in BMD is greater in women than in men. If confirmed in larger cohorts, these findings would suggest that the indication for immediate antiresorptive therapy after teriparatide may not be as urgent in men as in women. (J Clin Endocrinol Metab 94: 2915-2921, 2009)