Effects of Teriparatide and Sequential Minodronate on Lumbar Spine Bone Mineral Density and Microarchitecture in Osteoporosis

Abstract

The trabecular bone score (TBS) is a new surrogate for trabecular bone microarchitecture assessment, independent of bone mineral density (BMD), calculated from pixel gray-level variations in the lumbar spine (LS) dual-energy X-ray absorptiometry (DXA) image. Although Teriparatide (TPTD) increased LS-BMD as well as TBS in 2 years, the precise time-course of these parameters was not well known. The aim of this study was to determine the changes in LS-BMD and the TBS in osteoporotic patients treated with TPTD, followed by minodronate (MINO). Primary osteoporotic patients with a low LS-BMD (T-score < -2.5) and/or at least one vertebral fracture were treated with TPTD subcutaneously at 20 µg/day for 12-24 months, followed by MINO (orally at 50 mg/once monthly) for 12 months. LS-BMD and the TBS were measured at 0, 3, 6, 12, and 24 months after the initiation of TPTD treatment, and 12 months after the initiation of MINO. The increments of LS-BMD, significant at 6 months, increased until 12 months, whereas the increments of TBS, significant at 3 months (0.035 ± 0.011; p = 0.045 vs. the baseline), stabilized until 12 months. TPTD treatment, followed by 12 months of MINO, maintained both BMD and the TBS. Comparing the increments of the TBS to those of LS-BMD, our results indicate that TPTD treatment improved trabecular microarchitecture faster than mineralization. TPTD treatment, followed by MINO, can maintain both BMD and the TBS.

Effects of denosumab as compared with parathyroidectomy regarding calcium, renal, and bone involvement in osteoporotic patients with primary hyperparathyroidism

“…After 1 year, Dmb treatment in PHPT patients significantly improved LS-BMD by 6.0%, as well as TH-and FN-BMD, while LS-TBS by 3.0%, with those latter improvements consistent with though greater than previously reported in postmenopausal women with osteoporosis (5.7% and 1.4%, respectively) [13]. In addition, other prior reports including ours showed greater improvement in TBS with anabolic therapy such as teriparatide as compared with a bisphosphonate [27,28]. The potential mechanism by which Dmb, characterized as an anti-resorptive agent, causes improvement in TBS might be explained by a steady contribution of modeling-based bone formation [29].…”

Artificial neural network analysis of bone quality DXA parameters response to teriparatide in fractured osteoporotic patients

“…In the entire population PLOS ONE PLOS ONE studied both TBS and BSI, indexes of bone texture and strain, respectively, showed a significant amelioration, as well as BMD. For the last it is an expected and well-known result, while there are only few data [46,47] about TBS, confirming its increase after TPD as reported in other previous works [48]. As regards BSI, no data are available about its response to osteoporosis' treatment.…”

Clinical efficacy of denosumab, teriparatide, and oral bisphosphonates in the prevention of glucocorticoid-induced osteoporosis: a systematic review and meta-analysis

“…Teriparatide is a short-acting biological preparation, which is currently approved for 2 years. After discontinuation of treatment, the BMD will decrease rapidly, and it is recommended that treatment should be continued with bisphosphonates or denosumab to maintain the benefits of the treatment [ 45 , 46 ]. Nonetheless, it is noteworthy that discontinuation of denosumab results in a significant increase in bone turnover markers and the risk of BMD loss and vertebral fractures, and it even results in a rebound in treatment efficacy [ 47 , 48 ].…”