Clinical Study Of Teriparatide And Zoledronic Acid In The Treatment Of Postmenopausal Osteoporosis

Objective:To compare the efficacy and clinical safety of Tripatide(recombinant human parathyroid hormone 1-34)and Zoledronic acid for treatment of Postmenopausal osteoporosis.Methods: 103 patients with Postmenopausal osteoporosis admitted to Qingdao university affiliated hospital from December 2017 to December 2018 were analyzed retrospectively.Among them,there were 53 patients being treated with Triptaptide(20 μ g/ day,subcutaneous injection),50 patients treated with Zoledronic acid(5mg/ year,intravenous infusion),and all of those patients were administered with adequate calcium and Alfacalcidol at the same time.For further study,changes of bone mineral density(BMD)of the 1st-4th lumbar vertebra(L1-4),femoral neck,total hip,serum procollagen type 1 N—peptide(PINP),β-serum type I collagen carboxy-terminal peptide(β-CTX),serum alkaline phosphatase(ALP),general biochemical index(like blood calcium and blood phosphorus)and bone metabolism regulation hormone(like parathyroid hormone,25-hydroxy vitamin D3),level of visual analogue scale(VAS)and adverse drug reactions had been monitered since before medication,then reviewed in 3 months,6 months,12 months after treatment.Results:(1)There were no significant differences in age,menopausal age,body mass index(BMI),bone mineral density(BMD),bone turnover markers,general biochemical indicators(blood calcium,blood phosphorus),bone metabolic regulatory hormones(parathyroid hormone,25-hydroxyvitamin D3),score by visual analogue scale(VAS)of all patients between the two groups mentioned above.(2)change of BMD: after 3 months of treatment,comparing with the base line,there were no significant differences in the BMD of the 1-4 Lumbar vertebra,femoral neck,and total hip(P>0.05,after 6 months,the BMD of the 1-4 Lumbar vertebra,femoral neck,and total hip increased by 9.9%,4.9%,2.9% respectively in patients taking Triptaptide,then in 12 months after treatment,the changes become 15.9%,7.0%,and 6.6%,(P<0.05),and by 5.1%,3.8%,3.5% and 7.7%,6.5%,5.4% in Zoleidonic acid group(P<0.05).especially for the 1-4 Lumbar vertebra,the level of the BMD increased by Tripatide after6 and 12 months of treatment was better than that by Zoledronic(P<0.05),but there was no statistically significant difference between the two groups in other periods(P>0.05).(3)changes of bone turnover marjers: after 3,6 and 12 months of treatment,the level of PINP、β-CTX increased in Triptaptide group(P<0.05),yet decreased in patients using Zoledronic acid(P<0.05),for the level of ALP,in Triptaptide group,increase could be observed after 6 and 12 months of treatment(P<0.05),yet at the same time,in Zoleidonic acid group,there was the decrease inclination(P<0.05).On all accounts,there were significant differences between the two group concerning the level of PINP、β-CTX and ALP(P<0.05).(4)changes in general biochemical indicators:after treatment,the levels of blood calcium and blood phosphorus in both groups did not change significantly from the baseline(P>0.05),and there was no significant difference between the two groups during the same period(P>0.05).(5)changes in bone metabolism regulatory hormones: after 12 months of treatment,the level of25-hydroxyvitamin D3 in the two groups increased comparing with the baseline(P<0.05),and no significant difference was found in other periods of time(P >0.05).Changes of bone metabolism regulatory hormones: after 12 months of treatment,the level of 25-hydroxyvitamin D3 in the two groups increased compared with the baseline(P<0.05),and no significant difference was found in the remaining period(P>0.05).(6)changes in the score of the VAS: scores of both two groups decreased from the baseline level after treatment for all the time(P < 0.05),and patients in the Tripaseptide group were scored lower than those in the Zoledronic acid group(P<0.05).(7)no severe adverse events were seen in all patients,which may indicated high safety of the two medicines.Conclusion: Tripaseptide and Zoledronic acid can significantly improve bone mineral density,alleviate pain,and reduce the incidence of bone fractures in postmenopausal osteoporosis patients with high safety.However,in terms of improving bone mineral density of lumbar spine and reducing the score of the VAS,the therapeutic effect of Tripaseptide was better than that of Zoledronic acid.