요추 후외방 유합술 또는 후방 추체간 유합술을 시행한 골다공증 여성 환자에서 Teriparatide의 효과

서정호,이규열,김민우 대한척추외과학회 2015 대한척추외과학회지 Vol.22 No.3

Study Design: Retrospective study. Objectives: To investigate radiologic and clinical outcomes of teriparatide in women with osteoporosis after instrumented lumbar posterolateral fusion (PLF) or posterior lumbar interbody fusion (PLIF). Summary of Literature Review: Teriparatide accelerated lumbar posterolateral fusion in women with postmenopausal osteoporosis. Materials and Methods: Eighty-six women older than 65 years old with osteoporosis underwent PLF or PLIF with bone graft between Februar, 2011 ato May, 2012 pPatients were divided into four group: teriparatide group with local bone (A-1: 13 patients;, teriparatide group with composite bone (A-2: 27 patients; non-teriparatide group with local bone (B-1: 14 patients; and non-teriparatide group with composite bone (B-2: 32 patients). At 3, 6, and 12 months postoperatively, the Oswestry Disability Index (ODI), visual analog scale (VAS), fusion rate, and period of bone union were evaluated. Results: VAS and ODI improved after surgery in all groups, but no significant differences were notell among the groupses Further, there was no significant difference among the groups for agef fusion level, and fusiops(p>0.05). Fusion rate was 94.44% in the A-1 group, 92.59% in the A-2 group, 79.17% in the B-1 group, and 76.92% in the B-2 group. Average period of bone union was 3.25 months, 3.65 months, 5.67 months, and 5.65 months respectively. Fusion rate and average bone union time made no significant differeneen among the groups divided by graft materials (p>0.05). However, those in the teriparatide group were significantly superior to those in the nonteriparatide group (p<0.05). Conclusions: In women with osteoporosis after PLF or PLIF with bonegraft, teriparatide showed superiority in the rate of fusion and the period of bone union. 연구 계획: 후향적 연구목적: 요추 후외방 유합술 또는 후방 추체간 유합술을 시행한 골다공증이 있는 고령의 여성 환자에서 teriparatide의 임상적, 영상의학적 결과를 알아보고자 하였다. 선행 문헌의 요약: 최근 골다공증 환자에서 teriparatide가 치료 약물로 사용되고 있으며, 요추 후외방 유합술을 시행한 폐경 후 골다공증을 가진 여성 환자에서 teriparatide 투여는 술후 골유합을 촉진하였다. 대상 및 방법: 2011년 2월에서 2012년 5월까지 요추 후외방 유합술 또는 후방 추체간 유합술을 시행 받은 골다공증이 있는 65세 이상의 여성 86명에대해 술후 6개월간 teriparatide 투여한 군(A군) 40명과 대조군(B군) 46명으로 나누고, teriparatide 투여군을 자가 국소골만 쓴 군(A-1군) 13명과 자가 국소골과 동종골을 같이 쓴 군(A-2군) 27명으로 나누었다. 대조군 도 자가 국소골만 쓴 군(B-1군) 14명과 자가 국소골과 동종골을 쓴 경우(B-2군) 32명으로나누어 추시 3,6,12개월째 시각통증등급 점수와 Oswestry Disability Index의 임상적 결과와 CT 및 굴곡-신전 단순 방사선 사진으로 골유합율, 유합 기간등의 영상의학적 결과를 전향적으로 평가하였다. 결과: 술후 시각통증등급 점수와 Oswestry Disability Index는 모든 군에서 감소하였지만, teriparatide 투여 여부와 골이식 방법, 나이, 유합 레벨의 수, 유합 여부에 따른 유의한 차이는 없었다(p>0.05). 유합율은 A-1군에서 94.44%, A-2군 92.59%, B-1군 79.17%, B-2군 76.92%로 나타났으며, 평균 유합기간은 A-1군 3.25개월, A-2군 3.65개월, B-1군 5.67개월, B-2군 5.65개월이었다. 유합율 및 평균 유합 기간은 골이식 방법에 따른 차이는 보이지 않았으나(p>0.05), teriparatide 투여군에서 비투여군에 비해 유합율이 높고, 평균 유합 기간이 짧아 두 군간에 통계적으로 유의한 차이를 보였다(p<0.05). 결론: 골다공증을 동반한 고령의 여자 환자에서 요추 후외방 유합술 또는 후방 추체간 유합술과 골이식 시행 후 teriparatide의 투여는 술후 유합율을 증가시키고 유합 기간을 단축시키는 유용한 방법으로 사료된다.

골다공증이 있는 한국 폐경 여성에서 1년의 Teriparatide 치료 후 골밀도와 골교체 표지자

박선영,배재훈,김주영,오한진,주일우 대한골다공증학회 2010 Osteoporosis and Sarcopenia Vol.8 No.1

목적: 재조합 부갑상선 호르몬인 teriparatide는 골형성을 유도하고 척추 및 비척추 골절을 감소시킨다. 본 연구에서는 골다공증이 있는 한국 폐경 여성을 대상으로 1년의 teriparatide 치료 시 오는 골밀도와 골교체 표지자 변화를 평가하였다. 방법: 골다공증이 있는 폐경 여성이 등록되었고, 이들은 1년 동안 매일 자가로 teriparatide 20μg을 피하주사했다. 요추와 대퇴골 골밀도 및 골교체 표지자인 osteocalcin, C-telopeptide of collagen cross-links (CTX), alkaline phosphatase는 teriparatide 치료 전과 1년 후 측정되었다. 결과: 요추 골밀도는 teriparatide 치료 1년 후 유의하게 증가하였다(4.4%, P<0.01). 그러나 대퇴골 경부의 골밀도는 치료 시작 전보다 감소하였다(-9.7%, P<0.05). 골교체 표지자인 osteocalcin (148.5%), CTX (67.6%), alkaline phosphatase (56.7%)는 1년 후 모두 유의하게 증가하였다(P<0.001 for all). 결론: 골다공증이 있는 한국 폐경 여성에서 1년의 teriparatide 치료는 요추 골밀도와 골교체 표지자를 유의하게 증가시켰다. 앞으로 많은 사람을 대상으로 한 장기간의 체계화된 전향적 연구가 시행되어야 할 것이다.

Effectiveness of Weekly Teriparatide Injection in Postmenopausal Patients with Hip Fractures

Sangyeob Lee,Min-Seok Seo,Jun-Il Yoo 대한정형외과학회 2023 Clinics in Orthopedic Surgery Vol.15 No.4

Background: Teriparatide is an effective anabolic agent used in the treatment of severe osteoporosis. In addition, it is also used to promote fracture healing. The purpose of this double-blind randomized controlled trial was to evaluate the influence of weekly teriparatide administration on bone formation in hip fracture patients. Methods: The control group (n = 41) was composed of patients treated with normal saline other than teriparatide, and the teriparatide group (n = 51) consisted of patients who received weekly teriparatide. Bone turnover markers, C-terminal telopeptide (CTx) and osteocalcin (OC), were assessed through blood tests at the initial hospital visit and 3-month, 6-month, and 1-year follow-ups. Dual-energy X-ray absorptiometry was performed 5 days postoperatively and at 1-year postoperative follow-up. The degree of fracture union was evaluated by comparing the radiographic union scoring system for hips using Radiographic Union Score for Hip (RUSH) scores between the two groups at 3 months, 6 months, and 1 year after surgery. Results: Evaluation of the rate of change in bone mineral density over 1 year showed that the lumber bone mineral density increased by more than 7% in the experimental group. The control group did not show a difference between the CTx and OC at 6 months, but the difference between the CTx and OC values was large at 6 months in the experimental group. The mean RUSH score was significantly different between the control group and the experimental group: 12.105 and 15.476, respectively (p = 0.004), at 3 months and 18.571 and 22.389, respectively, at 6 months (p = 0.006). Conclusions: Weekly use of teriparatide improved fracture healing, bone formation, and clinical outcomes at 1 year after hip fracture surgery by the anabolic window effect.

골다공증 치료제 Teriparatide 치료 후의 중증 고칼슘혈증 1예

구자원,이상호,장나은,김혁,석화영,소예리,신아리,조주희 대한골대사학회 2012 대한골대사학회지 Vol.19 No.1

Recombinant human parathyroid hormone 1-34 (rHPTH; 1-34, teriparatide) increases bone mass and increases osteoporotic fracture by stimulating new bone formation. It was approved in the United States for treatment of osteoporosis in men and women, and its effectiveness and safety was proved. Mild hypercalcemia was observed, but persistent and severe hypercalcemia was not observed in the studies of teriparatide. In this case, severe hypercalcemia was developed from patient having gait disturbance who was treated with vitamin D, calcium and teripartide for two months to treat osteoporosis after subtrochanteric fracture. Hypercalcemia was resolved with discontinuation of teriparatide. Severe hypercalcemia is not a common complication of teriparatide and monitoring of serum calcium level is routinely not recommended. But it is necessary to pay close attention to patients who were treated with teriparatide, especially in immobilized patients. 부갑상선호르몬 (테리파라타이드) 치료는 골의 동화작용을 촉진시킴으로써 골밀도를 증가시키는 약물로 폐경 후 골다공증 여성과 골절 위험이 높은 남성의 골다공증 환자의 치료제로 사용되고 있으며, 그 효과와 안정성이 입증되었다. 테리파라타이드 사용에 의한 경미한 고칼슘혈증은 보고되고 있으나, 중증의 고칼슘혈증의 보고는 매우 드물다. 본 증례는 대퇴골 골절로 수술 시행 후 골다공증 치료를 위해 비타민 D와 칼슘제제 및 테리파라타이드를 2개월간 사용한 이후 중증의 고칼슘혈증이 발생했던 경우로 문헌 고찰과 함께 보고하는 바이다.

건강보험 청구자료를 이용한 골다공증 치료제의 처방 양상과 골형성촉진제 처방에 미치는 영향요인

정지혜,신주영 한국임상약학회 2021 한국임상약학회지 Vol.31 No.1

Objective: To analyze osteoporosis treatment patterns and teriparatide prescription-associated factors in Korea by using a national health insurance claims database. Methods: We utilized the Health Insurance Review & Assessment Service National Patients Sample claims database to identify patients (aged ≥50 years) with at least one osteoporosis claim (International Classification of Disease 10th revision code: M80, M81, M82) and at least one prescription for osteoporosis medication (antiresorptive agents: bisphosphonates, selective estrogen receptor modulators, denosumab, and calcitonin; bone-forming agent: teriparatide) in 2018. Demographic characteristics and healthcare utilization patterns were analyzed. Factors associated with teriparatide prescriptions were assessed using a multivariate logistic regression model. Results: Records showed that 44,815 patients were prescribed osteoporosis medications in 2018; the percentage of patients prescribed each treatment was as follows: 86.6% bisphosphonates, 13.9% selective estrogen receptor modulators, 3.1% calcitonin, 2.1% denosumab, and 0.7% teriparatide. A greater proportion of patients prescribed teriparatide were ≥75 years (53.4% vs. 33.8%) and had fractures (63.9% vs. 12.8%) compared to the same for antiresorptives (p<0.001). Patients prescribed teriparatide had higher Charlson comorbidity index values (1.2±1.3 vs. 0.9±1.2) and were more frequently hospitalized (0.8±1.3 vs. 0.1±0.5) than those prescribed antiresorptives (p<0.001). Elderly patients (≥75 years old; adjusted OR=1.66; 95% CI 1.16-2.38) and those with fractures (adjusted OR=6.23; 95% CI 4.76-8.14) were more likely to be prescribed teriparatide than antiresorptives. Conclusion: Patients prescribed teriparatide were older and more likely to have severe osteoporosis than those prescribed antiresorptives.

Utility of radius bone densitometry for the treatment of osteoporosis with once-weekly teriparatide therapy

Harumi Nakayama,Hiroyuki Toho,Teruki Sone 대한골다공증학회 2018 Osteoporosis and Sarcopenia Vol.4 No.1

Objectives: As clinics that treat patients with osteoporosis do not usually have central dual-energy X-ray absorptiometry (DXA), bone density is often measured with radial DXA. However, no long-term evidence exists for radius bone density outcomes following treatment with once-weekly teriparatide in actual medical treatment. Methods: We evaluated changes in bone density at 6-, 12-, and 18-month intervals using radial DXA in patients treated with once-weekly teriparatide for more than 6 months. Results: A significant increase in bone mineral density (BMD) was observed at the 1/3 and 1/10 radius sites 12 months after the initiation of once-weekly teriparatide. We also observed that the rate of change in BMD was greater at the distal 1/10 radius than at the 1/3 radius. Conclusions: Considering these points, the effect of once-weekly teriparatide therapy can be observed at the radius. In clinics that do not have central DXA, but instead have radial DXA, these findings can help to evaluate the effect of once-weekly teriparatide treatment on osteoporosis.

Can Three Months of Teriparatide Be One of Treatment Options for Osteoporotic Vertebral Compression Fracture Patients?

강정훈,양상미,임수빈,정제훈 대한신경손상학회 2019 Korean Journal of Neurotrauma Vol.15 No.1

Objective: Osteoporosis is one of the most common causes of vertebral compressionfractures (VCFs). Teriparatide, a recombinant human parathyroid hormone, is the frstanabolic agent for the treatment of osteoporosis. The aim of this study was to determinewhether 3 months of teriparatide could be effective for patients with osteoporotic VCF at thethoracolumbar spine. Methods: We reviewed 25 patients with thoracolumbar osteoporotic compression fracturesbetween July 2012 and October 2016 who could be followed up for more than 1 year. Patientswere divided into 2 groups depending on the use of teriparatide: 14 patients receivedteriparatide through subcutaneous injection (group I) and 11 patients did not receiveteriparatide (group II). Demographic data, bone mineral density, hospitalization period,changes in the visual analogue scale (VAS) score, body mass index, and medical historysuch as smoking, alcohol, diabetes, and steroid usage were reviewed. Radiographs were alsoreviewed to evaluate vertebral body compression percentages and kyphotic angles. Results: Overall changes of VAS score between injury and follow-up were statisticallyimproved in both groups at 2 to 3 weeks post-injury. However, difference in VAS improvementat a specifc time between the 2 groups was not statistically signifcant. Overall kyphoticangle and compression percentage between injury and follow-up time were increasedin group II than those in group I, although the difference between the 2 groups was notstatistically signifcant. Conclusion: Three-month of teriparatide did not show protective effects on progression offractured vertebral body collapse or kyphotic changes in patients with osteoporosis

Extracorporeal Shock Wave Combined with Teriparatide-Loaded Hydrogel Injection Promotes Segmental Bone Defects Healing in Osteoporosis

Chen Qi,Xia Chen,Shi Binbin,Chen Chuyong,Yang Chen,Mao Guangfeng,Shi Fangfang 한국조직공학과 재생의학회 2021 조직공학과 재생의학 Vol.18 No.6

BACKGROUND: Osteoporosis is a systemic bone disease characterized by decreased bone density and deterioration of bone microstructure, leading to an increased probability of fragility fractures. Once segmental bone defect occurs, it is easy to cause delayed union and nonunion. METHODS: The aim of this study is to investigate the efficacy of extracorporeal shock wave (ESW) and teriparatide-loaded hydrogel (T-Gel) combined strategy on the cell activity and differentiation of osteoporosis derived bone marrow mesenchymal stem cells (OP-BMSCs) in vitro and bone regeneration in osteoporotic segmental bone defects in vivo. RESULTS: In vitro, the strategy of combining ESW and T-Gel significantly enhanced OP-BMSCs proliferation, survival, migration, and osteogenic differentiation by up-regulating the alkaline phosphatase activity, mineralization, and expression of runt-related transcription factor-2, type I collagen, osteocalcin, and osteopontin. In the segmental bone defect models of osteoporotic rabbits, Micro-CT evaluation and histological observation demonstrated this ESW-combined with T-Gel injection significantly induced bone healing by enhancing the osteogenic activity of the local microenvironment in osteoporotic defects. CONCLUSION: In conclusion, ESW-combined with T-Gel injection could regulate the poor osteogenic microenvironment in osteoporotic defects and show potential for enhancing fragility fractures healing. BACKGROUND: Osteoporosis is a systemic bone disease characterized by decreased bone density and deterioration of bone microstructure, leading to an increased probability of fragility fractures. Once segmental bone defect occurs, it is easy to cause delayed union and nonunion. METHODS: The aim of this study is to investigate the efficacy of extracorporeal shock wave (ESW) and teriparatide-loaded hydrogel (T-Gel) combined strategy on the cell activity and differentiation of osteoporosis derived bone marrow mesenchymal stem cells (OP-BMSCs) in vitro and bone regeneration in osteoporotic segmental bone defects in vivo. RESULTS: In vitro, the strategy of combining ESW and T-Gel significantly enhanced OP-BMSCs proliferation, survival, migration, and osteogenic differentiation by up-regulating the alkaline phosphatase activity, mineralization, and expression of runt-related transcription factor-2, type I collagen, osteocalcin, and osteopontin. In the segmental bone defect models of osteoporotic rabbits, Micro-CT evaluation and histological observation demonstrated this ESW-combined with T-Gel injection significantly induced bone healing by enhancing the osteogenic activity of the local microenvironment in osteoporotic defects. CONCLUSION: In conclusion, ESW-combined with T-Gel injection could regulate the poor osteogenic microenvironment in osteoporotic defects and show potential for enhancing fragility fractures healing.

Post Pregnancy Severe Spinal Osteoporosis with Multiple Vertebral Fractures and Kyphoscoliosis in a Multigravida: A Rare Case with Management

Shailesh Hadgaonkar,Kunal Chandrakant Shah,Hrutvij Bhatt,Ashok Shyam,Parag Sancheti 대한척추외과학회 2015 Asian Spine Journal Vol.9 No.4

Osteoporosis associated with pregnancy and lactation is a less commonly known condition and often overlooked. The prevalence, exact aetiology and its pathogenesis are unknown. It is commonly seen in first three months after delivery in primigravida. It is often undiagnosed because of it not suspected n and X-rays and densitometry are avoided if possible during pregnancy and lactation. If missed, it can lead to osteoporotic fractures and disability. In this paper, we report a case of a 24-year-old multigravida 4 months after pregnancy with multiple vertebral compression fractures and kyphoscoliosis. Her metabolic workup was normal but bone densitometry revealed severe osteoporosis of the dorso-lumbar spine. Immediate weaning and antiresorptives like bisphosphonates and teriparatide are used as first line drugs to manage postpartum spinal osteoporosis. Our patient presented at 4 month lactation and did not want to wean her infant, so she was treated with total contact orthosis and took vitamin D and calcium. The pain was relieved within 3 months but there was no improvement in bone density. After eight months when the infant was weaned, she was treated with teriparatide. After one year of teriparatide therapy, there were no new fractures and densitometry scores improved.

Teriparatide사용 후 고칼슘혈증으로 진단된 원발성 부갑상선 기능항진증의 1예

김다희,김지원,박준형,성준민,김형영,김정민 대한골다공증학회 2015 Osteoporosis and Sarcopenia Vol.13 No.1

Primary hyperparathyroidism is a disease that causes hypercalcemia and abnormal bone metabolism due to an increase in parathyroid hormones, and the occurrence rate of bone fracturing is higher in patients with primary hyperparathyroidism. Parathyroid hormones have recently frequently been used as an osteogenesis catalyst treatment for osteoporosis in the elderly. This research study examined the case study that was experienced on the diagnosis and treatment of primary hyperparathyroidism caused by adenoma and extreme hypercalcemia that was discovered in menopausal women with bone fractures and extreme osteoporosis.