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1.
The importance of bisphosphonate therapy in maintaining bone mass in men after therapy with teriparatide [human parathyroid hormone(1–34)] 总被引:2,自引:2,他引:0
Etah S. Kurland Samantha L. Heller Beverly Diamond Donald J. McMahon Felicia Cosman John P. Bilezikian 《Osteoporosis international》2004,15(12):992-997
Teriparatide, the active fragment of human parathyroid hormone (hPTH 1–34), is an anabolic agent for the treatment of osteoporosis. Important questions remain regarding management strategy beyond the recommended 18- to 24-month course of teriparatide treatment. We followed 21 men for up to 2 years after discontinuing teriparatide. Twelve men (57%) chose treatment with bisphosphonate immediately after teriparatide withdrawal, while 9 (43%) opted for no pharmacologic agent. At the end of 1 year lumbar spine bone density increased an additional 5.1±1.0% in the bisphosphonate group, while it declined by 3.7±1.7% in those on no medication (P<0.002). In six men who delayed initiation of bisphosphonate until 1 year after teriparatide withdrawal, their subsequent gains in the second year, 2.6±1.7%, still placed them below the peak gains they achieved on teriparatide. In contrast, the 12 men who began bisphosphonates immediately and continued treatment for the entire 2-year post-PTH period had continued gains at the lumbar spine, 8.9±1.5% above their post-PTH values (P=0.002). For the 4-year period, including 2 years of teriparatide and 2 years of bisphosphonate, the total gains at the lumbar spine were 23.6±2.9%. Men, who received bisphosphonate in only the 2nd year post-teriparatide, had cumulative gains of 11.1±3.4%. Three men who did not receive any bisphosphonate at any time during the post-PTH period had cumulative gains of only 5.5±3.7%. These findings suggest that the use of bisphosphonates following teriparatide is an important component of any strategy utilizing this anabolic drug for osteoporosis in men. The immediate use of bisphosphonates after teriparatide withdrawal may help to optimize gains in bone density at the lumbar spine. 相似文献
2.
R. Lindsay P. Miller G. Pohl E. V. Glass P. Chen J. H. Krege 《Osteoporosis international》2009,20(6):943-948
Summary The extent to which fracture protection and safety varies with increasing time on teriparatide [rhPTH(1-34)] therapy is a
clinically relevant unanswered question. In postmenopausal women with osteoporosis, increased duration of teriparatide versus
placebo treatment was associated with a progressive decrease in the rates of nonvertebral fragility fractures and back pain.
Introduction The impact of duration of teriparatide [rhPTH(1-34)] therapy on patient outcomes is a relevant unanswered question.
Methods Postmenopausal women with osteoporosis were randomized to once-daily subcutaneous injection with placebo (N = 544), teriparatide 20 μg (TPTD20; N = 541), or teriparatide 40 μg (TPTD40; N = 552) plus calcium and vitamin D supplementation. The time to first nonvertebral fragility fracture and new or worsening
back pain following treatment initiation was analyzed using Cox partial likelihood regression treating time on therapy as
a linear, time-dependent covariate.
Results Compared with placebo, the relative hazard for nonvertebral fragility fractures decreased by 7.3% for each additional month
of TPTD20 [hazard ratio = 0.927, 95% CI (0.876 to 0.982), p = 0.009] and by 7.6% for each additional month of TPTD40 [hazard ratio = 0.924, 95% CI (0.871 to 0.981), p = 0.009]. Clinical vertebral fractures appeared to increase over time in the placebo group and occurred primarily in the
first time interval in the teriparatide treatment groups. Compared with placebo, the relative hazard of back pain was decreased
by 8.3% for each additional month of TPTD20 [hazard ratio = 0.920, 95% CI (0.902 to 0.939), p < 0.001] and 8.7% for each additional month of TPTD40 [hazard ratio = 0.917, 95% CI (0.898 to 0.935), p < 0.001].
Conclusions These findings suggest increased nonvertebral fracture protection, reduced back pain, and reduced occurrence of side effects
with longer duration of teriparatide therapy.
Some of these findings were presented at the 67th Annual Scientific Meeting of the American College of Rheumatology in Orlando,
Florida, October 23–28, 2003 and at the 31st European Symposium on Calcified Tissues in Nice, France, June 5–9, 2004. 相似文献
3.
M. Duyvendak M. Naunton J. Atthobari P. B. van den Berg J. R. B. J. Brouwers 《Osteoporosis international》2007,18(10):1429-1433
Summary We investigated prevention trends and predictors for osteoporosis prevention in long term corticosteroid users. The use of
bisphosphonates increased from 2001 to 2005. Longer duration of corticosteroid use and DMARD use were predictors for receiving
prevention. Females appear reasonably well treated; however, men require more attention.
Introduction Previous studies have shown that long-term corticosteroid users are undertreated for osteoporosis prevention. Our aim was
to identify prevention trends in long-term corticosteroid users from 2001–2005 in The Netherlands and to identify predictors
for bisphosphonate prophylaxis.
Methods Pharmacy dispensing data were used from 9 community pharmacies. All oral corticosteroid doses were converted to “prednisolone
equivalents”. We then identified long-term (≥90 days) corticosteroid episodes, which required bisphosphonate prophylaxis as
per 2002 Dutch guidelines; Multivariate logistic regression was used to identify predictors for receiving prevention.
Results We identified 615 different corticosteroid patients requiring prophylaxis. From 2001–2005 the use of bisphosphonates increased
from 38% to 54% (p = 0.001). In 2005 females were prescribed more bisphosphonates than males (61% vs. 39%; p = 0.002), or
any treatment (72% vs. 45%; p < 0.001). Multivariate analysis showed that longer duration of corticosteroid use and disease-modifying
anti-rheumatic drug (DMARD) use were independent predictors of bisphosphonate use. Use of respiratory medication was a negative
predictor of bisphosphonate use.
Conclusion There has been a significant increase in osteoporosis prophylaxis in a population at high risk for osteoporosis/fractures.
In particular, females appear reasonably well treated; however, men are still not receiving prevention to the same degree
as women. 相似文献
4.
B. L. Langdahl F. Marin E. Shane H. Dobnig J. R. Zanchetta M. Maricic K. Krohn K. See M. R. Warner 《Osteoporosis international》2009,20(12):2095-2104
Summary
The effects of teriparatide versus alendronate were compared by gender and menopausal status in patients with glucocorticoid-induced osteoporosis. At 18 months, increases in lumbar spine BMD were significantly greater in the teriparatide versus alendronate group in postmenopausal women (7.8% versus 3.7%, p < 0.001), premenopausal women (7.0% versus 0.7%, p < 0.001), and men (7.3% versus 3.7%, p = 0.03). 相似文献5.
S. A. Foster K. A. Foley E. S. Meadows J. A. Johnston S. S. Wang G. M. Pohl S. R. Long 《Osteoporosis international》2011,22(2):551-557
Summary
Adherence to, and persistence with, treatments for osteoporosis are low. Adherence with teriparatide decreases over time. Higher copayments in the commercial/Medicare population were associated with worse persistence. Understanding factors such as prior screening, prior treatment history, and out of pocket costs that influence persistence with teriparatide may help clinicians make informed decisions.Introduction
The purpose of this study was to evaluate adherence and persistence with teriparatide.Methods
Beneficiaries with at least one claim for teriparatide in 2003 or 2004 and continuous enrollment in the previous 12?months and subsequent 6?months were identified in a national commercial/Medicare and Medicaid administrative claims database (MarketScan?). Adherence was assessed through calculation of the medication possession ratio (MPR). Persistence was measured by time until discontinuation and time until first 60-day gap in treatment. Factors associated with persistence were assessed using Cox proportional hazards models.Results
The average MPR at 6?months was 0.74 (N?=?2,218) and at 12?months, was 0.66 (N?=?1,303). At 6?months, 64.6% of patients remained on therapy and at 12?months, 56.7% remained. Bone mineral density screening and use of antiresorptive therapy within the 12?months pre-period, and lower patient copayments were associated with increased persistence.Conclusion
Patients appear to have good adherence with teriparatide over the first 6?months which declines over time. Prior screening and treatment of osteoporosis and out of pocket costs appear to impact persistence. To optimize patient outcomes, clinicians should consider clinical factors that impact persistence, while healthcare decision makers should consider the negative effect of higher patient copayments on persistence. 相似文献6.
H. Ideguchi S. Ohno K. Takase A. Ueda Y. Ishigatsubo 《Osteoporosis international》2008,19(12):1777-1783
Summary Most patients who switched to a second bisphosphonate continued their treatment long term, although those who stopped their
first drug because of adverse events were likely to discontinue the second drug for the same reason. Switching to another
bisphosphonate is a reasonable treatment option for some patients with treatment failure.
Introduction Patients who experience treatment failure with a bisphosphonate because of adverse events (AEs) or other reasons might receive
a second bisphosphonate. However, the frequency and benefits of switching bisphosphonates are unknown.
Methods We retrospectively evaluated 197 men and 1110 women newly treated with bisphosphonates between 1 January 2000 and 30 June
2005 at our university hospital.
Results Among the 497 patients who discontinued bisphosphonate treatment, 146 were switched to a second bisphosphonate. The cumulative
probabilities of persistence of treatment after 3 years were 45% with the first bisphosphonate and 65% with the second (P = 0.017). Age ≥65 years, switching bisphosphonates because of AEs, and male gender were associated (P < 0.05) with low persistence of treatment with the second bisphosphonate. Discontinuation of the first drug because of AEs
was associated with an increased rate of discontinuation of the second drug because of AEs (hazard ratio, 4.2; 95% confidence
interval, 2.1–8.4).
Conclusions Patients who switched bisphosphonates had high rates of persistence of therapy. Those who stopped their first bisphosphonate
because of AEs were at risk of discontinuing the second drug for the same reason. Switching to another bisphosphonate is a
reasonable treatment option for some patients with treatment failure.
Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorized users. 相似文献
7.
L. A. Beaupre D. W. Morrish D. A. Hanley W. P. Maksymowych N. R. Bell A. G. Juby S. R. Majumdar 《Osteoporosis international》2011,22(3):983-991
Summary
Intravenous bisphosphonates reduce mortality following hip fracture. We determined whether new use of oral bisphosphonates was also associated with reductions in mortality in 209 hip fracture patients. Oral bisphosphonate exposure led to relative reduction of 8% per month of use (p = 0.001) or about a 60% reduction in mortality per year of use. 相似文献8.
Risk of hip fracture after bisphosphonate discontinuation: implications for a drug holiday 总被引:1,自引:1,他引:0
J. R. Curtis A. O. Westfall H. Cheng E. Delzell K. G. Saag 《Osteoporosis international》2008,19(11):1613-1620
Summary Based upon interest in a bisphosphonate drug holiday, we evaluate the risk for hip fracture after bisphosphonate discontinuation.
Among women compliant with bisphosphonates for ≥2 years, the risk of hip fracture was increased after discontinuation, although
with higher compliance and a longer duration of preceding bisphosphonate therapy, this risk was attenuated.
Introduction Recent data suggest that hip fracture risk was not significantly increased among women receiving 5 years of bisphosphonate
therapy who were subsequently randomized to placebo. We studied older women compliant with bisphosphonates ≥2 years to evaluate
the risk of hip fracture after bisphosphonate discontinuation.
Methods Using administrative databases from a large U.S. healthcare organization, we identified women initiating bisphosphonate therapy
compliant (Medication Possession Ratio, MPR ≥66%) for 2 years. We examined the rate of hip fracture among women who discontinued
bisphosphonates versus those who remained on therapy.
Results At 2 years, 9,063 women were eligible for analysis. Hip fracture incidence among women who discontinued bisphosphonates versus
those who did not was 8.43 versus 4.67 per 1000 person years (p = 0.016). The adjusted hazard ratio of hip fracture per 90 days following discontinuation was 1.2 (1.1–1.3). For women with
higher compliance at 2 years (MPR ≥80%) or compliant for 3 years, there were no significant differences in risk associated
with discontinuation.
Conclusions The rate of hip fracture was increased among women compliant with bisphosphonate therapy for 2 years who subsequently discontinued,
suggesting that discontinuation is not advisable under these conditions. This association was attenuated with higher compliance
and a longer duration of previous bisphosphonate therapy.
Funding This project was funded by Novartis Pharmaceuticals and the Arthritis Foundation. The investigators also receive support
from the National Institutes of Health (AR053351, AR052361). The authors independently developed the analysis plan, extracted
the data, conducted the analysis, and interpreted the results. 相似文献
9.
Christina Keel Marius E. Kraenzlin Claude A. Kraenzlin Beat Müller Christian Meier 《Journal of bone and mineral metabolism》2010,28(1):68-76
Concurrent use of bisphosphonate therapy reduces the anabolic effect of teriparatide. Consequently, in clinical practice bisphosphonates are discontinued and teriparatide therapy held for a few months to allow bone turnover to increase. We aimed to evaluate the effect of prior bisphosphonate exposure and the effect of bisphosphonate wash-out on the treatment response to teriparatide. Thirty-nine patients with primary osteoporosis (mean age 63.6 ± 14.0 years), including 26 patients previously treated with oral bisphosphonates (median duration 53 months) and 13 bisphosphonate-naïve patients were started on teriparatide (20 μg daily) and followed prospectively over 12 months. The primary study outcome was change in bone formation markers (PINP, bone ALP, osteocalcin). Secondary outcomes included changes in bone resorption (βCTX) and 12-month changes in BMD. Markers of bone formation increased early during teriparatide therapy and were followed by an increase in βCTX (p < 0.001). The magnitude of the increase in bone markers was comparable in both patient groups irrespective of prior bisphosphonate exposure; similarly, increases in BMD after 12 months were not significantly different between bisphosphonate-pretreated and bisphosphonate-naïve patients (lumbar spine 7.1 vs. 8.9%, p = 0.58; total hip 4.1 vs. 1.1%, p = 0.48). The response of teriparatide was not related to the duration of bisphosphonate wash-out (median duration 4.2 months). This study confirms that beneficial effects of teriparatide on intermediate bone endpoints can be translated into clinical practice with less constringent methodological circumstances than in RCTs. Furthermore, as bisphosphonate wash-out does not appear to influence the treatment effect, teriparatide therapy can be started immediately after ceasing bisphosphonate therapy and wash-out. 相似文献
10.
E. Barrett-Connor K. Ensrud A. N. A. Tosteson S. F. Varon M. Anthony N. Daizadeh S. Wade 《Osteoporosis international》2009,20(3):463-472
Summary Failure to take prescribed medication is common. The POSSIBLE US™ study is evaluating the impact of physician and patient
characteristics on patient-reported compliance and persistence with osteoporosis medications. We report our study design and
the baseline characteristics of 4,994 postmenopausal women recruited from primary care physician offices in 33 states.
Introduction The Prospective Observational Scientific Study Investigating Bone Loss Experience (POSSIBLE US™) is a longitudinal cohort
study of osteoporosis therapy in primary care.
Methods Between 2004 and 2007, 134 physicians (in 33 states) enrolled postmenopausal women initiating, changing, or continuing osteoporosis
medications. After completing a baseline questionnaire, participants will provide data semi-annually for up to 3 years through
2008. Physicians provide patient data at baseline and routine follow-up visits. Participants from 23 sites also signed a release
regarding administrative claims data for economic analyses and validation of self-reported data.
Baseline results Four thousand nine hundred and ninety-four evaluable women were recruited from internal medicine (n = 1,784), family practice (n = 1,556), obstetrics/gynecology (n = 1,556), and from one rheumatology practice (n = 98). Mean participant age was 64.3 years (SD = 9.97); 89% were Caucasian; 59% had some college education. Sixty-three percent
used a single osteoporosis agent, usually a bisphosphonate. For monotherapy patients, concordance between clinic- and patient-reported
medication use was lowest for patients prescribed estrogen therapy (70%) or calcium/vitamin D (72%). Obstetrician/gynecologists
enrolled younger women, who were more likely to use estrogen therapy than patients enrolled by other physicians. The 934 women
(19%) prescribed only calcium/vitamin D were younger than women prescribed pharmacologic therapy.
Conclusions POSSIBLE US™ provides a unique foundation for evaluating longitudinal use of osteoporosis medications and related outcomes. 相似文献
11.
Association of low-energy femoral fractures with prolonged bisphosphonate use: a case--control study
S. D. Vasikaran 《Osteoporosis international》2009,20(8):1457-1458
Summary Recent evidence has linked long-term bisphosphonate use with insufficiency fractures of the femur in postmenopausal women.
In this case–control study, we have identified a significant association between a unique fracture of the femoral shaft, a
transverse fracture in an area of thickened cortices, and long-term bisphosphonate use. Further studies are warranted.
Introduction Although clinical trials confirm the anti-fracture efficacy of bisphosphonates over 3–5 years, the long-term effects of bisphosphonate
use on bone metabolism are unknown. Femoral insufficiency factures in patients on prolonged treatment have been reported.
Methods We performed a retrospective case–control study of postmenopausal women who presented with low-energy femoral fractures from
2000 to 2007. Forty-one subtrochanteric and femoral shaft fracture cases were identified and matched by age, race, and body
mass index to one intertrochanteric and femoral neck fracture each.
Results Bisphosphonate use was observed in 15 of the 41 subtrochanteric/shaft cases, compared to nine of the 82 intertrochanteric/femoral
neck controls (Mantel–Haenszel odds ratio (OR), 4.44 [95% confidence interval (CI) 1.77–11.35]; P = 0.002). A common X-ray pattern was identified in ten of the 15 subtrochanteric/shaft cases on a bisphosphonate. This X-ray
pattern was highly associated with bisphosphonate use (OR, 15.33 [95% CI 3.06–76.90]; P < 0.001). Duration of bisphosphonate use was longer in subtrochanteric/shaft cases compared to both hip fracture controls
groups (P = 0.001).
Conclusions We found a significantly greater proportion of patients with subtrochanteric/shaft fractures to be on long-term bisphosphonates
than intertrochanteric/femoral neck fractures. Bisphosphonate use was highly associated with a unique X-ray pattern. Further
studies are warranted. 相似文献
12.
Ayano Sugie-Oya Aya Takakura Ryoko Takao-Kawabata Hiroko Sano Yukari Shimazu Yukihiro Isogai Akira Yamaguchi Toshinori Ishizuya 《Journal of bone and mineral metabolism》2016,34(3):303-314
Teriparatide and bisphosphonates are osteoporosis medications that increase bone mineral density (BMD) and prevent fracture, but each has a different mechanism of action. Teriparatide promotes bone formation, while bisphosphonates suppress bone resorption. In the clinical setting, however, drug selection is not always tailored to the particular clinical condition of the patient or mechanism of action of the drug. We compared the effects of teriparatide and the bisphosphonate risedronate on bone metabolism using two ovariectomized rat models to elucidate the optimal use of these two drugs in the clinical setting. We first performed dose-finding experiments to determine the equivalent effective doses of each drug (5.6 and 3.0 µg/kg for teriparatide and risedronate, respectively). We then compared the effects of these doses on bone metabolism after subcutaneous administration three times weekly for 4 months starting either the day after ovariectomy (preventive study) or 12 months after ovariectomy (therapeutic study). The increase in proximal tibial BMD under the physical conditions that increased bone turnover at 1 to 2 months after ovariectomy was greater in the risedronate group than in the teriparatide group. In contrast, the increases in lumbar vertebral BMD and bone strength under the physical conditions that significantly decreased BMD and bone strength at 12 months after ovariectomy were greater in the teriparatide group than in the risedronate group. The present study provides important information on the selection of antiosteoporotic drugs, including teriparatide and risedronate, in treatment protocols tailored to the clinical conditions of patients and drug mechanisms. 相似文献
13.
Fumito Yoshiki Atsushi Nishikawa Masanori Taketsuna Kenta Kajimoto Hiroyuki Enomoto 《Journal of orthopaedic science》2017,22(2):330-338
Background
Teriparatide is the first anabolic agent shown to reduce the risk of fractures in patients with osteoporosis. In Japan, teriparatide is prescribed to treat patients at high risk of fracture. Given that bisphosphonates are commonly used prior to teriparatide as treatment for osteoporosis, information on the effectiveness and safety of teriparatide with or without previous bisphosphonate treatment is helpful for physicians in clinical practice. This study aims to report the effectiveness and safety of teriparatide in treatment-naive and bisphosphonate-pretreated patients in Japan as real-world evidence.Methods
A post hoc analysis of a postmarketing surveillance study was conducted in Japanese patients with osteoporosis at high risk of fracture who received 24-month treatment of daily teriparatide. Changes in bone turnover biomarkers and bone mineral density and incidence of new fractures were analyzed in treatment-naive as well as bisphosphonate-pretreated patients.Results
The analysis included 1433 patients (treatment-naive, n = 659; bisphosphonate-pretreated, n = 774). Bone mineral density increased significantly from baseline at 24 months in both treatment-naive (lumbar spine, 13.45%; femoral neck, 5.16%; total hip, 4.46%) and bisphosphonate-pretreated (lumbar spine, 11.20%; femoral neck, 2.22%; total hip, 0.67%) patients. The incidence rates of new vertebral and nonvertebral fractures at 24 months were 1.69% and 3.37%, respectively, in treatment-naive patients and 3.60% and 5.56%, respectively, in bisphosphonate-pretreated patients. The incidence of adverse drug reactions was 6% in treatment-naive patients and 10% in bisphosphonate-pretreated patients. The most common adverse drug reaction in treatment-naive and bisphosphonate-pretreated patients was nausea (0.91%) and hyperuricaemia (1.81%), respectively.Conclusions
In this post hoc analysis, no new safety concerns and similar effectiveness of teriparatide were observed in Japanese patients with osteoporosis at high risk of fracture, regardless of their previous treatment status with bisphosphonates. 相似文献14.
Summary
Compliance and persistence to bisphosphonates amongst Singaporean patients with osteoporosis were estimated. Mean medication possession ratio (MPR) ± standard deviation (SD) was 78.9 ± 27.5%, and 69.0% was persistent at 1 year. In contrast to US and Europe where poor adherence is noted, our study suggests higher adherence rates to bisphosphonate therapy amongst patients. 相似文献15.
Jiannong Liu Andrew Laster Xiaoqing Xu Haifeng Guo Mary Oates Shravanthi R. Gandra 《Journal of bone and mineral research》2021,36(12):2309-2316
The 2020 American Association of Clinical Endocrinologists guidelines for assessing osteoporosis among postmenopausal women stratified postmenopausal women with osteoporosis to “high” and “very-high” fracture risk categories and recommended anabolic agents as initial therapy followed by an antiresorptive agent. Switching the order can blunt the effect of anabolic agents, and failing to follow with an antiresorptive can lead to loss of bone generated by the anabolic agent. It would be helpful to understand the real-world prescribing patterns of anabolic agents. Using the 2010–2015 Medicare 100% osteoporosis database, we assessed patient profiles, teriparatide prescribers, persistence of teriparatide therapy, and antiresorptive agent use after teriparatide discontinuation among elderly women who initiated teriparatide from 2011 to 2013. This study included 14,786 patients. In the year before teriparatide initiation, 30.0% of them had a fracture, 67.6% had a dual energy x-ray absorptiometry scan, 74.4% had a diagnosis of osteoporosis, and 47.9% used antiresorptive agents (non-naïve teriparatide users). Among those who had fractures, 49.4% initiated teriparatide within 3 months postfracture. Teriparatide was prescribed for 37% of users by primary care doctors, 19% by rheumatologists, 13% by endocrinologists, and 7.0% by orthopedists. Median time of teriparatide use was 7.2 months. After teriparatide discontinuation, 40.8% switched to antiresorptive agents (31.9% among naïve teriparatide users, 50.5% among non-naïve users). Among switchers, 42.5% switched within 60 days, 50.5% switched to denosumab, and 31.6% switched to oral bisphosphonates. This study of real-world prescribing data found that about half of teriparatide users switched from an antiresorptive agent, and less than half switched to antiresorptive agents after teriparatide discontinuation. Persistence of teriparatide use was suboptimal. In the management of postmenopausal osteoporosis, increasing the persistence of teriparatide use and improving the appropriate treatment sequence of anabolic and antiresorptive drugs are critical to maximizing gains in bone mass, providing the greatest protection against fractures. © 2021 American Society for Bone and Mineral Research (ASBMR). 相似文献
16.
Michael C. Nevitt Peiqi Chen Robin K. Dore Jean-Yves Reginster Douglas P. Kiel Jose R. Zanchetta Emmett V. Glass John H. Krege 《Osteoporosis international》2006,17(2):273-280
Vertebral fractures are the most common osteoporotic fracture and may result in back pain with functional limitations and diminished quality of life. Teriparatide [rhPTH (1–34)] has been shown to increase bone mass and reduce the risk of vertebral and other osteoporotic fractures. The aim of this study was to evaluate the effects of teriparatide on the risk of back pain in patients with osteoporosis. A systematic review of the literature was performed, and five trials were identified and included in our analyses. All trials were randomized, double-blinded, and parallel with either new vertebral fracture ( n =1) or bone mineral density as the primary endpoint ( n =4). Four studies were in postmenopausal women with osteoporosis, and one was in men with idiopathic or hypogonadal osteoporosis. Two trials were placebo controlled, two trials were alendronate controlled, and one trial involved teriparatide plus hormone replacement therapy versus hormone replacement therapy alone. Reports of back pain, defined as new or worsened back pain after initiating the study drug, were obtained from adverse event databases, and the risk of back pain was analyzed using a multivariate Cox proportional hazards model. Results were not statistically heterogeneous ( P =0.60) across trials, and there were no differences between groups administered teriparatide 20 or 40 mcg/day doses ( P =0.64). The rates of back pain, moderate or severe back pain, and severe back pain per 100 patient-years were numerically lower in the teriparatide versus comparator groups in each study. Compared with the pooled comparator, patients in the pooled teriparatide group had reduced risk for any back pain [relative risk, 0.66 (95% CI, 0.55–0.80)], moderate or severe back pain [relative risk, 0.60 (95% CI, 0.48–0.75)] and severe back pain [relative risk, 0.44 (95% CI, 0.28–0.68)]. Separate meta-analyses comparing teriparatide versus placebo or antiresorptive drugs gave similar results. In conclusion, patients randomized to teriparatide had a reduced risk of new or worsening back pain compared to patients randomized to placebo, hormone replacement therapy or alendronate. 相似文献
17.
S. Adami J. San Martin M. Muñoz-Torres M. J. Econs L. Xie G. P. Dalsky M. McClung D. Felsenberg J. P. Brown M. L. Brandi A. Sipos 《Osteoporosis international》2008,19(1):87-94
Summary Loss of bone mineral density occurs after discontinuation of teriparatide, if no subsequent treatment is given. Sequential
raloxifene prevented rapid bone loss at lumbar spine and further increased bone mineral density (BMD) at femoral neck, whether
raloxifene was started immediately or after a one-year delay following teriparatide treatment.
Introduction We compared the sequential effects of raloxifene treatment with a placebo on teriparatide-induced increases in bone mineral
density (BMD). A year of open-label raloxifene extended the study to assess the response with and without delay after discontinuation
of teriparatide.
Methods Following a year of open-label teriparatide 20 μg/day treatment, postmenopausal women with osteoporosis were randomly assigned
to raloxifene 60 mg/day (n = 157) or a placebo (n = 172) for year 2, followed by a year of open-label raloxifene. BMD was
measured by dual energy x-ray absorptiometry.
Results The raloxifene and placebo groups showed a decrease in lumbar spine (LS) BMD in year 2 for raloxifene and placebo groups (−1.0 ± 0.3%,
P = 0.004; and −4.0 ± 0.3%, P < 0.001, respectively); the decrease was less with raloxifene (P < 0.001). Open-label raloxifene
treatment reversed the LS BMD decrease with a placebo, resulting in similar decreases 2 years after randomization (−2.6 ± 0.4%
(raloxifene-raloxifene) and −2.7 ± 0.4% (placebo-placebo). At study end, LS and femoral neck (FN) BMD were higher than pre-teriparatide
levels, with no significant differences between the raloxifene-raloxifene and placebo-raloxifene groups, respectively (LS:
6.1 ± 0.5% vs. 5.1 ± 0.5%; FN: 3.4 ± 0.6% vs. 3.0 ± 0.5%).
Conclusion Sequential raloxifene prevented rapid bone loss at the LS and increased FN BMD whether raloxifene was started immediately
or after a one-year delay following teriparatide treatment.
Preliminary data presented previously at the International Osteoporosis Foundation World Congress on Osteoporosis, Toronto
Canada June 2–6, 2006, abstract published: Adami S, Munoz-Torres M, Econs MJ, Sipos A, Xie L, Dalsky GP, McClung M, Felsenberg
D, Brown JP, Brandi ML, San Martin J. Effect of raloxifene after teriparatide treatment in postmenopausal women with osteoporosis.
Osteoporos Int. 2006;17(Suppl 2):S137. 相似文献
18.
N. Miyakoshi Y. Kasukawa H. Sasaki K. Kamo Y. Shimada 《Osteoporosis international》2009,20(7):1193-1198
Summary Spinal kyphosis has been speculated to participate in the increased frequency of gastroesophageal reflux disease (GERD) in
patients with osteoporosis. The present study provides further evidence that increases in lumbar kyphosis and number of vertebral
fractures represent very important risk factors for GERD in patients with osteoporosis.
Introduction Osteoporosis and spinal kyphosis have been speculated to participate in the increased frequency of gastroesophageal reflux
disease (GERD). The present study examined whether GERD in patients with osteoporosis is affected by spinal factors including
spinal kyphosis in the presence of oral pharmacotherapies.
Methods Subjects comprised 112 patients with osteoporosis (mean age, 78 years) who responded to the Frequency Scale for Symptoms of
GERD (FSSG) questionnaire, regardless of complaints. Relationships between total FSSG score and number of vertebral fractures,
angles of kyphosis, use of bisphosphonates and nonsteroidal anti-inflammatory drugs (NSAIDs), and total number of oral medicines
per day were evaluated. Logistic regression identified factors associated with GERD.
Results Bisphosphonates and NSAIDs did not affect total FSSG score. Total FSSG score showed significant positive correlations with
total number of medicines (r = 0.283, p = 0.0025), angle of lumbar kyphosis (r = 0.576, p = 0.0001), and numbers of thoracic vertebral fractures (r = 0.214, p = 0.0232) and lumbar vertebral fractures (r = 0.471, p < 0.0001). Angle of lumbar kyphosis and number of lumbar vertebral fractures were identified by multivariate analysis as
indices affecting the presence of GERD.
Conclusion Increases in angle of lumbar kyphosis and number of lumbar vertebral fractures may5 represent very important risk factors
for GERD in osteoporotic patients. 相似文献
19.