Teriparatide Therapy Reduces Serum Phosphate and Intima-Media Thickness at the Carotid Wall Artery in Patients with Osteoporosis

Abstract

Although cross-sectional and longitudinal studies report a relationship between osteoporosis and cardiovascular disorders (known as the bone-cardiovascular axis), the benefits of osteoporosis treatment on atherosclerosis are largely unclear. Teriparatide is a bone-forming agent that increases urinary phosphate excretion. Because elevated serum phosphate is associated with the development of atherosclerosis, the purpose of our study was to examine the relationship among lumbar spine bone mineral density (LS-BMD), intima-media thickness at the carotid artery (CA-IMT), and phosphate metabolism in response to daily teriparatide therapy. Osteoporotic patients (n = 28) with low LS-BMD (T-score < -2.5) and/or at least one vertebral fracture were treated with teriparatide (20 μg/day) for 12 months. Metabolic bone markers, LS-BMD, and CA-IMT were measured over the course of treatment. The LS-BMD significantly increased by 0.046 ± 0.038 g/cm(2) over the 12-month period (P < 0.001). CA-IMT decreased from 0.701 mm (interquartile range: 0.655-0.774 mm) at baseline to 0.525 mm (0.477-0.670 mm) at 12 months (P < 0.05); however, CA-IMT change was not significantly associated with LS-BMD change. Serum phosphate decreased after 1 month of teriparatide administration, and the change in serum phosphate at 1 months was associated with the change in CA-IMT at 12 months (ρ = 0.431, P = 0.025). Teriparatide improved LS-BMD and CA-IMT, suggesting the existence of the bone-cardiovascular axis. The association between serum phosphate and CA-IMT suggests that the teriparatide decreased CA-IMT in part by reducing serum phosphate, a well-known vascular toxin, in addition to the improvement of bone-cardiovascular axis.

Relationship between bone turnover and left ventricular function in primary hyperparathyroidism: The EPATH trial

“…In rats with induced myocardial infarction PTH application led to mobilization of angiogenic progenitor cells from bone marrow and improved survival and reduced infarct size compared to sham treatment, probably via promoting VEGF-mediated cardiac neovascularization [34]. Also in humans, PTH administration was associated with increases in circulating hematopoietic stem cells and an improvement in carotid intima-media thickness [35, 36]. Patients with pHPT exhibited higher numbers of circulating bone marrow derived progenitor cells compared to healthy controls, and increased VEGF levels [37].…”

Effect of teriparatide treatment on endothelial function, glucose metabolism and inflammation markers in patients with postmenopausal osteoporosis

“…31 Baykan et al 32 reported a significant decrease in FMD % in 21 patients with primary hyperparathyroidism compared to control group. Yoda et al 33 observed a decrease in LDL and increase in HDL levels in 28 osteoporotic patients treated with teriparatide for 12 months period. In the present study, we evaluated the effects of intermittent teriparatide treatment for 6 months on endothelial function assessed by ultrasonography and on biochemical markers for inflammation and atherosclerosis in postmenopausal osteoporosis patients.…”

“…reported a significant decrease in FMD% in 21 patients with primary hyperparathyroidism compared to control group. Yoda et al . observed a decrease in LDL and increase in HDL levels in 28 osteoporotic patients treated with teriparatide for 12 months period.…”

Atherosclerosis and Osteoporosis. Common Targets for the Effects of Cardiovascular and Anti-Osteoporotic Drugs (Part II). The Effect of Antiosteoporotic Drugs on the Vascular Wall State

“…Также авторы отметили снижение уровня фосфата сыворотки уже через 1 мес после первого введения терипаратида, которое прямо коррелировало с изменением толщины КИМ сонных артерий к концу курса терапии (r=0,431, р=0,025). Авторы предполагают, что уменьшение толщины КИМ может быть частично обусловлено снижением сывороточного фосфата, оказывающего «токсический» эффект на сосудистую стенку [38].…”