| Objective:To compare the efficacy of denosumab and zoledronic acid as a sequential therapy in postmenopausal osteoporosis patients which has treated with teriparatide,and to provide more evidence for the selection of drugs for teriparatide’s sequential therapy.Research methods:Takinig 95 patients with postmenopausal osteoporosis treated with teriparatide(20μg/day,subcutaneous injection)for 2 years in the Affiliated Hospital of Qingdao University from June 2016 to December 2020 as an object,dividing them by the subsequent therapy into three groups: zoledronic acid group(n=36)treated with zoledronic acid(5 mg/ year,intravenous infusion),denosumab group(n=29)treated with denosumab(60mg/ 6months,subcutaneous injection),and control group(n=30)with no follow-up treatment.All the three groups were supplemented with sufficient calcium and vitamin D.The main outcome measures were bone mineral density(BMD)of lumbar spine(L1-4),femoral neck and total hip after 12 months’ treatment.The secondary outcome measures were the changes of PINP and β-CTX after 12 months’ treatment.Bone mineral density(BMD)was measured by dual energy X-ray absorptiometry(DXA).Body mass index(BMI),vitamin D,serum calcium,serum phosphorus,serum parathyroid hormone,and bone metabolic markers were collected.Statistical processing: SPSS 25.0 statistical software was used for data analysis.Measurement data were described as median ± interquartile,and rank sum test was used for comparison between the two groups,p< 0.05 was considered statistically significant.Findings:(1)There were no significant differences in age,body mass index(BMI),BMD of lumbar spine,total hip and femoral neck,β-CTX and PINP among the three groups before treatment(p>0.05).(2)After teriparatide’s treatment,there were no significant differences in bone mineral density and bone metabolism markers among the three groups.After teriparatide treatment,lumbar spine BMD increased by 11.19%(p<0.01).The bone mineral density of femoral neck and hip did not change significantly.β-CTX(p<0.01)and PINP(p<0.01).(3)After sequential treatment,the overall BMD of the sequential group increased,and the lumbar spine increased by 2.50%(p<0.01),hip bone mineral density increased by 2.00%(p<0.01),femoral neck BMD increased by3.20%(p<0.05),β-CTX decreased by 0.41pg/ml,PINP decreased by 76.2ug/L,and the differences were statistically significant.(4)The efficacy of denosumab9.326%(6.7%,16.3%)as sequential administration in lumbar spine was better than that of zoledronic acid 6.695%(4.5%,8.5%),p=0.003.Both denosumab 5.953%(3.5%,12.1%)and zoledronic acid 4.129%(0.3%,12.2%)could improve hip bone mineral density,and there was no significant difference between them(p=0.647).There was no significant difference in the change of femoral neck’s BMD after the treatment with zoledronic acid(p=0.103),while denosumab has(p=0.015).Denosumab was superior to zoledronic acid in improving the femoral neck’s BMD.(5)In the control group,the BMD of lumbar spine decreased by 9.389%(-12.7%,-5.2%),p<0.01,hip decreased by4.314%(-9.6%,-0.4%),p<0.01,and femoral neck decreased by 9.105%(-15.2%,-7.0%),p<0.01,after 1 year without the drug,and the difference was statistically significant.Conclusions and implications:As a sequential medication after teriparatide has stopped,denosumab and zoledronic acid can both continue improving lumbar spine and hip’s BMD,and denosumab is better than zoledronic acid in improving lumbar spine’s BMD.Zoledronic acid has no meaningful effect on improving in femoral neck’s BMD,but it can still maintained femoral neck’s BMD compared with control group.Denosumab is more recommended as the first choice to treat patients after teriparatide withdrawal. |
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