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      Impacto del tratamiento con teriparatida en la calidad de vida de las personas con osteoporosis Translated title: Impact of Teriparatide on Quality of Life in Osteoporotic Patients

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          Abstract

          Fundamentos: La pérdida ósea en pacientes osteoporóticos, conlleva riesgo de fracturas, dolor óseo vertebral y disminución de la calidad de vida. El objetivo de este trabajo fue analizar el efecto de la teriparatida (TPTD) en pacientes osteoporóticos y con dolor vertebral. Métodos: Estudio observacional longitudinal prospectivo, entre abril de 2006 y febrero de 2014, en los 77 pacientes tratados con TPTD en la Unidad del Dolor del Hospital de Teruel. La duración del tratamiento fue de 18 o 24 meses. Se utilizó la Escala Visual Analógica (EVA) para la medición del dolor y el cuestionario europeo de calidad de vida (EuroQol-5D) para obtener la tarifa social (TS), antes y después el tratamiento. Se realizó un análisis descriptivo, de regresión lineal y logística. Resultados: Se observó una mejoría del dolor (80%) y de la calidad de vida (65%). Se mejoró la EVA media (5,42 a 3,47 puntos) y el EuroQol-5D (0,36 a 0,58 puntos). La regresión indicó una mejora de la EVA en 0,441 puntos por cada punto de EVA inicial, y de la TS en 0,0528 puntos por cada 0,1 puntos de TS inicial. La probabilidad de mejorar la EVA en 3 puntos (OR = 2,021), fue mayor que de mejorar 2 puntos (OR = 1,695). Conclusiones: La TPTD en pacientes osteoporóticos reduce el dolor óseo y mejora la calidad de vida. Su efecto es mayor en pacientes con peor estado de salud inicial, pudiendo ser utilizado como criterio para las decisiones terapéuticas y de gestión clínica.

          Translated abstract

          Background: Lost bone in osteoporotic patients increases the risk of fractures and back pain, and decreases quality of life. The aim of this study was to analyse the effect of teriparatide (TPTD) in osteoporotic patients with vertebral pain. Methods: A prospective observational study between April 2006 and February 2014 was done with 77 patients treated with teriparatide in the Pain Unit of Hospital Obispo Polanco of Teruel (Spain). Treatment duration was 18 or 24 months. Pain was assessed by the Visual Analogue Scale (VAS). Health-related quality of life was measured using the European Quality of Life Questionnaire (EuroQol-5D) in order to obtain the social tariff (ST). Pre and post-treatment values were collected respectively. A descriptive and regression analysis was done. Results: Improvement in pain was observed (80%) and in health-related quality of life (65%). The mean VAS improved (from 5.42 to 3.47 points) and the mean health status value too (from 0.36 to 0.58 points). The regression indicated an improvement of VAS in 0.441 for each initial VAS point, and of ST in 0.0528 points for each 0.1 initial ST point. The probability of VAS reduction in 3 points (OR = 2.021) was greater than in 2 points (OR = 1.695). Conclusions: TPTD reduces pain and improves quality of life of osteoporotic patients. The worse the baseline situation, the more patients' health improved, so it could be used as criteria for therapeutic decisions and health management.

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          Effects of teriparatide versus alendronate for treating glucocorticoid-induced osteoporosis: thirty-six-month results of a randomized, double-blind, controlled trial.

          To compare the bone anabolic drug teriparatide (20 microg/day) with the antiresorptive drug alendronate (10 mg/day) for treating glucocorticoid-induced osteoporosis (OP). This was a 36-month, randomized, double-blind, controlled trial in 428 subjects with OP (ages 22-89 years) who had received > or =5 mg/day of prednisone equivalent for > or =3 months preceding screening. Measures included changes in lumbar spine and hip bone mineral density (BMD), changes in bone biomarkers, fracture incidence, and safety. Increases in BMD from baseline were significantly greater in the teriparatide group than in the alendronate group, and at 36 months were 11.0% versus 5.3% for lumbar spine, 5.2% versus 2.7% for total hip, and 6.3% versus 3.4% for femoral neck (P < 0.001 for all). In the teriparatide group, median percent increases from baseline in N-terminal type I procollagen propeptide (PINP) and osteocalcin (OC) levels were significant from 1 to 36 months (P < 0.01), and increases in levels of C-terminal telopeptide of type I collagen (CTX) were significant from 1 to 6 months (P < 0.01). In the alendronate group, median percent decreases in PINP, OC, and CTX were significant by 6 months and remained below baseline through 36 months (P < 0.001). Fewer subjects had vertebral fractures in the teriparatide group than in the alendronate group (3 [1.7%] of 173 versus 13 [7.7%] of 169; P = 0.007), with most occurring during the first 18 months. There was no significant difference between groups in the incidence of nonvertebral fractures (16 [7.5%] of 214 subjects taking teriparatide versus 15 [7.0%] of 214 subjects taking alendronate; P = 0.843). More subjects in the teriparatide group (21%) versus the alendronate group (7%) had elevated predose serum calcium concentrations (P < 0.001). Our findings indicate that subjects with glucocorticoid-induced OP treated with teriparatide for 36 months had greater increases in BMD and fewer new vertebral fractures than subjects treated with alendronate.
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            Circulating irisin is associated with osteoporotic fractures in postmenopausal women with low bone mass but is not affected by either teriparatide or denosumab treatment for 3 months.

            In vitro data suggest that myokine irisin may affect bone metabolism by promoting osteoblast differentiation while inhibiting osteoclast differentiation. In this study, circulating irisin levels were associated with previous osteoporotic fractures but not with bone mass and were not affected by denosumab or teriparatide treatment for 3 months. This study aimed to evaluate predictors of circulating irisin in postmenopausal women with low bone mass and to assess a potential effect of denosumab or teriparatide treatment for 3 months. Serum samples for irisin measurement were obtained from (a) postmenopausal women with low bone mass (lumbar spinal [LS] or femoral neck [FN] bone mineral density [BMD] T-score ≤-2.0) and their age-matched controls at baseline and 3 months after denosumab (Dmab) injection (Dmab group, n = 50; Dmab control group, n = 25) and (b) women with more severe disease (LS or FN BMD T-score ≤-2.8) and their age-matched controls at the above-mentioned time points after teriparatide (TPTD) initiation (TPTD group, n = 25; TPTD control group, n = 25). At baseline, irisin levels were inversely correlated with age (partial coefficient (r p ) = -0.24; p = 0.009), parathyroid hormone (PTH) (r p  = -0.30; p = 0.001), and creatinine (r p  = -0.23; p = 0.016) in univariate analysis, and were lower in women with (n = 26; 41.6 ± 2.7 ng/dL) than without previous osteoporotic fracture(s) (n = 99; 51.0 ± 1.6 ng/dL; p = 0.007). In multiple linear regression, previous osteoporotic fracture(s) and PTH were independently negatively associated with irisin [p = 0.04, CI -16.1 to -0.4 and p = 0.002, CI -0.3 to -0.07, respectively], but only the association with PTH remained after controlling for creatinine levels. Serum irisin levels were not different between women with or without low bone mass and were not affected by either Dmab or TPTD treatment for 3 months. Circulating irisin levels were associated with previous osteoporotic fracture(s); whether this association is independent or is due to confounding by lower muscle mass, potentially reflected by lower creatinine levels, remains to be fully clarified.
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              Effects of two years of daily teriparatide treatment on BMD in postmenopausal women with severe osteoporosis with and without prior antiresorptive treatment.

              Previous antiresorptive (AR) treatment may influence the response to teriparatide. We examined BMD response and safety in a subgroup of 503 postmenopausal women with osteoporosis who received teriparatide for 24 mo. Patients were divided into three groups based on their prior AR treatment: treatment-naïve (n = 84); pretreated with no evidence of inadequate treatment response (n = 134); and pretreated showing an inadequate response to AR treatment (n = 285), which was predefined based on the occurrence of fractures, persistent low BMD, and/or significant BMD loss while on therapy. Changes in BMD from baseline were analyzed using mixed model repeated measures. Lumbar spine BMD increased significantly from baseline at 6, 12, 18, and 24 mo in all three groups. The mean gain in spine BMD over 24 mo was greater in the treatment-naïve group (0.095 g/cm(2); 13.1%) than in the AR pretreated (0.074 g/cm(2); 10.2%; p < 0.005) and inadequate AR responder (0.071 g/cm(2); 9.8%; p < 0.001) groups. The corresponding increases in total hip BMD were 3.8%, 2.3%, and 2.3%, respectively. Early decreases in hip BMD in the inadequate AR responder group were reversed by 18 mo of treatment. Increases in BMD between 18 and 24 mo were highly significant. Nausea (13.3%) and arthralgia (11.7%) were the most commonly reported adverse events. Asymptomatic hypercalcemia was reported in 5.0% of patients. Teriparatide treatment for 24 mo is associated with a significant increase in BMD in patients with and without previous AR use. Prior AR treatment modestly blunted the BMD response to teriparatide. Safety was consistent with current prescribing label information.
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                Author and article information

                Journal
                resp
                Revista Española de Salud Pública
                Rev. Esp. Salud Publica
                Ministerio de Sanidad, Consumo y Bienestar social (Madrid, Madrid, Spain )
                1135-5727
                2173-9110
                April 2015
                : 89
                : 2
                : 215-225
                Affiliations
                [02] Valencia orgnameUniversitat Politècnica de Valencia orgdiv1Departamento de Economía y Ciencias Sociales
                [01] Teruel orgnameHospital Obispo Polanco orgdiv1Servicio de Anestesiología y Reanimación orgdiv2Unidad del Dolor
                Article
                S1135-57272015000200009 S1135-5727(15)08900200009
                10.4321/S1135-57272015000200009
                df22ae40-ea2b-4499-9afa-de7cadc53b0c

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 International License.

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                Dolor de espalda,Teriparatido,Quality of life,Osteoporosis,Back pain,Teriparatide,Calidad de vida

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