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18-mesačná liečba teriparatidom zlepšuje u pacientov s glukokortikoidmi indukovanou osteoporózou hodnoty hustoty kostného minerálu a trabekulárne kostné skóre: výsledky prospektívneho sledovania (register OSTEO.sk)

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Authors: Payer Juraj 1;  Tomková Soňa 2;  Killinger Zdenko 1;  Brázdilová Kristina 1;  Jackuliak Peter 1;  Vaňuga Peter 3;  Letkovská Alexandra 4;  Masaryk Pavol 4;  Kmečová Zlata 5;  Kužma Martin 1
Authors‘ workplace: Comenius University Medical Faculty, 5th Department of Internal Medicine, University Hospital Bratislava, Slovakia 1;  Osteocentrum, Hospital Košice-Šaca, Košice, Slovakia 2;  National Institute of Endocrinology and Diabetology, Lubochňa, Slovakia 3;  National Institute of Rheumatic Diseases, Piešťany, Slovakia 4;  Osteocentrum of F. D. Roosevelt Faculty Hospital, Banská Bystrica, Slovakia 5
Published in: Clinical Osteology 2018; 23(4): 138-145
Category:

Overview

Úvod:

Liečba glukokortikoidmi má za následok rýchlu stratu denzity kostného minerálu (BMD) a glukokortikoidmi indukovaná osteoporóza (GIOP) je najčastejšou a závažnou formou sekundárnej osteoporózy. Liečba žien s post­menopauzálnou osteoporózou teriparatidom (TPTD) významne zvyšuje trabekulárny kostný objem a konektivitu, zlepšuje trabekulárnu morfológiu s posunom smerom k viac doštičkovitej štruktúre a zvyšuje hrúbku kortikálnej kosti.

Ciel štúdie:

Posúdení zmeny BMD a trabekulárneho kostného skóre (TBS) po 12- a 18-mesačnej liečbe TPTD u pacientov s GIOP.

Pacienti a metódy:

Prospektívne multicentrické, nekontrolované sledovanie účinnosti a bezpečnosti liečby TPTD u pacientov s GIOP, uskutočňované v 5 špecializovaných centrách ustanovených pre liečbu TPTD. U všetkých pacientov zaradených do registru OSTEO.sk bolo pravidelne uskutočňované meranie BMD v bedrovej chrbtici a proximálnom femoru a sledovanie markerov kostného obratu. V podskupine účastníkov bolo merané TBS.

Výsledky:

Z celkového počtu 263 pacientov zaradených do registra bolo do záverečnej analýzy zahrnutých 129 pacientov (20 mužov vo veku 51,5 let/109 žien vo veku 59,7 let). Po liečbe TPTD bol zistený v porovnaní s východiskovými hodnotami nárast BMD v bedrovej chrbtici v 12. mesiaci (+ 8,3 %, p < 0,001) a v 18. mesiaci nárast BMD hlavica femoru (+ 3,85 %, p < 0,001), krčku femoru (+ 3,26 %, p < 0,001) a bedrovej chrbtice (+ 9,28 %, p < 0,001). V podskupine (n = 12) v priebehu prvých 12 mesiacov narástlo TBS o 2,4 % (p = 0,01). 18-mesačná liečba TPTD viedla k významnému zvýšení markerov kostného obratu.

Záver:

18-mesačná liečba TPTD viedla k významnému zvýšeniu BMD so súčasným zvýšením všetkých hodnotených markerov kostného obratu. Okrem toho bolo v podskupine účastníkov štúdie pozorované zvýšenie TBS po 12 mesiacoch liečby. Podľa týchto výsledkov bolo preukázané, že u pacientov s GIOP je TPTD vysoko účinný osteoanabolický liek.

Klíčová slova:

kostná minerálna denzita (BMD) – osteoporóza indukovaná glukokortikoidmi (GIOP) – trabekulárne kostné skóre (TBS) – teriparatide

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