Quantitative computed tomographic assessment of the effects of 24 months of teriparatide treatment on 3D femoral neck bone distribution, geometry, and bone strength: Results from the EUROFORS study
- 27 January 2010
- journal article
- clinical trial
- Published by Oxford University Press (OUP) in Journal of Bone and Mineral Research
- Vol. 25 (3), 472-481
- https://doi.org/10.1359/jbmr.090820
Abstract
We studied the changes in bone distribution, geometry, and bone strength based on 3D quantitative computed tomography (QCT) of the femoral neck (FN) in subjects receiving teriparatide (TPTD). Fifty-two postmenopausal women with severe osteoporosis were analyzed. Patients were divided into three subgroups based on their prior treatment with osteoporosis drugs: treatment-naive (Tx-naive; n = 8), pretreated (pre-Tx; n = 12), and pretreated showing an inadequate response to treatment (inad. pre-Tx; n = 32). QCT scans were performed at baseline and after 6, 12, and 24 months of treatment and were analyzed with Mindways QCT-PRO BIT software. Minimum and maximum section modulus, buckling ratio (BR), and cross-sectional area (CSA) were calculated as measurements of bending strength, risk of buckling, and bone apposition, respectively. After 24 months of TPTD treatment, areal and volumetric FN BMD increased significantly by 4.0% and 3.0%, respectively, compared with baseline. Decreases in cortical volumetric BMD occurred in locations not adversely affecting minimum bending strength indicators. Cortical CSA increased by 4.3%, whereas total CSA remained unchanged over the study duration, indicating that endosteal but no periosteal growth was observed. Strength parameters for buckling did not change at 6 and 12 months but improved significantly at 24 months. Measures of bending strength showed a trend toward improvement. Changes tended to be larger in individuals at higher risk of buckling failure. Prior antiresorptive treatment may delay response to TPTD, but based on the small magnitude of the mostly insignificant changes at 6 months, this does not appear to lead to an interim phase of reduced bone strength. In summary, FN QCT provides a tool for detailed longitudinal investigation of bone strength indices in vivo for different loading modes, yields insight into underlying structural changes, and provides relevant mechanostructural information beyond dual-energy X-ray absorptiometry. Continuous TPTD treatment for 24 months improves FN bone strength parameters.Keywords
This publication has 36 references indexed in Scilit:
- Intermittent PTH stimulates periosteal bone formation by actions on post-mitotic preosteoblastsBone, 2008
- European guidance for the diagnosis and management of osteoporosis in postmenopausal womenOsteoporosis International, 2008
- Prediction of mechanical properties of cortical bone by quantitative computed tomographyMedical Engineering & Physics, 2007
- Effects Of a One-Month Treatment With PTH(1–34) on Bone Formation on Cancellous, Endocortical, and Periosteal Surfaces of the Human IliumJournal of Bone and Mineral Research, 2007
- Bone loss in elderly men: increased endosteal bone loss and stable periosteal apposition. The prospective MINOS studyOsteoporosis International, 2007
- Femoral neck shape and the spatial distribution of its mineral mass varies with its size: Clinical and biomechanical implicationsBone, 2005
- Teriparatide [PTH(1–34)] Strengthens the Proximal Femur of Ovariectomized Nonhuman Primates Despite Increasing PorosityJournal of Bone and Mineral Research, 2004
- Structural Adaptation to Changing Skeletal Load in the Progression Toward Hip Fragility: The Study of Osteoporotic FracturesJournal of Bone and Mineral Research, 2001
- Intermittently Administered Human Parathyroid Hormone(1–34) Treatment Increases Intracortical Bone Turnover and Porosity Without Reducing Bone Strength in the Humerus of Ovariectomized Cynomolgus MonkeysJournal of Bone and Mineral Research, 2001
- Distribution of Trabecular and Cortical Bone Related to GeometryInvestigative Radiology, 1997