Comparison Of Teriparatide And Zoledronic Acid In Post-Menopausal Women With Multiple Osteoporotic Vertebral Fractures

Abstract

\n Objective: This retrospective comparative study was aimed to make a comparison between Teriparatide and Zoledronic Acid to provide evidence for the sequential treatment of multiple vertebral fractures caused by osteoporosis of postmenopausal women.Methods: A sum of 106 post-menopausal women undergoing non-operative treatment for recent multiple osteoporotic vertebral fractures between April,2015 and June,2019 were reviewed retrospectively. 44 patients had a treatment of subcutaneous injection of 20 micrograms teriparatide once a day (TPTD group), while 62 patients received 5 mg of zoledronic acid given by an intravenous (IV) infusion once a year (ZOL group). The assessment methods included the general information of patients, the number of new fractures and changes in bone turnover markers, bone mineral density(BMD), back pain and health-related quality of life.Results: Teriparatide was more effective than zoledronic acid in reducing the risk of new vertebral fractures. The lumbar spine BMD rosed significantly in either treatment groups relative to the baseline (P＜0.05). However, the TPTD group increased more than the ZOL group. The hip joint BMD also increased significantly in all groups between months 0 and 12 relative to the baseline（P＜0.05）, no significant differences were found between the changes of two groups after 6 months, but the TPTD group was significantly higher than the ZOL group at 12 months（P＞0.05). In the TPTD group, the values of TP1NP increased 55.9% and 70.8% from baseline(71.69±33.45ng/ml P＜0.05). The values of β-CTX increased from baseline(0.807±0.657ng/ml) to (0.842±0.528)ng/ml at 6 months and the value got back to the baseline at 12 months after the TPTD used. In the ZOL group, the values of TP1NP and β-CTX decreased significantly compared with baseline (69.55±39.15ng/ml, 0.691±0.456ng/ml) 6 months after treatment, which were (33.19±16.81)ng/ml and (0.422±0.267)ng/ml respectively（P＜0.05. No significant changes were found 12 months after treatment compared with the conditions of 6 months(P＞0.05). In both TPTD and ZOL treatment groups, there were significant and clinically relevant improvements in back pain as well as health-related quality of life indicators compared with baseline. Conclusions: TPTD is more advantageous in reducing new fractures, increasing lumbar spine and hip joint BMD and reducing patients back pain compared with ZOL. TPTD significantly increased marker of bone formation along with slightly increased marker of bone resorption, while ZOL decreased them. This provides a theoretical basis for the apply of Zoledronic acid after discontinuation of teriparatide.