The Effect Of Baseline Serum 25-hydroxyvitamin D Level In Postmenopausal Osteoporosis Patients Treated With Teriparatide

Objective : To determine whether the baseline serum 25-hydroxyvitamin D level at initiation of Teriparatide(h PTH(1-34))therapy for postmenopausal osteoporosis patients affects treatment efficacy.Methods:We studied 103 women with postmenopausal osteoporosis under treatment with teriparatide(20 ug/day,subcutaneous injection)in the affiliated Hospital of Qingdao University from April to September in 2017-2019.The patients were classified as vitamin D insufficiency(VD insufficiency group,10ng/ml < 25 OHD < 30 ng/ml,n=60)and vitamin D sufficiency(VD sufficiency group,30 ng/ml ≤25OHD<150ng/ml,n=43)at the baseline.BMD was measured at baseline,6 and 12 months at the lumbar spine(LS),femoral neck(FN)and total hip(TH).Bone turnover markers,serum calcium,phosphorus,25(OH)D and PTH were measured before treatment and after three,six,twelve months of treatment.The VAS score was used to evaluate the level of pain before and after treatment.Statistical analyses were performed using SPSS version 25.0 and the data were expressed as mean ± standard deviation((?)±S).The independent sample t test was used for comparison between the two groups.Repeated measures analysis of variance was used to compare the changes in the observation indicators of the same group in different periods.Observations were considered significant if two-sided P values were <0.05.Results:(1)There was no evident difference in age,weight,height,body mass index,menopausal age,menopause time,baseline bone mineral density,PINP,CTX,PTH,serum calcium and phosphorus levels between VD deficiency group and sufficient group.(2)The bone mineral density of lumbar vertebrae in both groups increased observably at6 months and 12 months after treatment(P < 0.05).There was no evident difference in BMD of femoral neck and total hip between the two groups after 6 months of treatment(P >0.05),but there was a evident increase after 12 months of treatment(P < 0.05).The lumbar spine in VD sufficient group and VD deficiency group increased by 5.64% and 5.50%respectively after 6 months treatment.After 12 months of treatment,the bone mineral density of lumbar spine,femoral neck and total hip in the two groups increased by 11.14%,3.65%,3.52%,10.09%,3.48% and 3.36%,respectively.However,there was no evident difference in bone mineral density between the two groups(P > 0.05).(3)The levels of PINP and CTX in the two groups were observably higher after 3,6,12 months of treatment(P < 0.05).After 12 months of treatment,the level of PINP in the VD sufficient group was observably higher than that in the VD deficiency group,and the level of CTX in the VD sufficient group was observably lower than that in the VD deficiency group(P < 0.05).(4)After 12 months of treatment,25(OH)D levels increased 11.3% and 9.5% respectively,in the VD-deficient and VD-sufficient groups(P < 0.05).(5)There were no evident changes in serum calcium and phosphorus levels after treatment(P > 0.05).(6)Teriparatide could reduce the VAS score and relieve pain,but the baseline serum 25-hydroxyvitamin D level had no evident effect on it(P > 0.05).Conclusion:For patients with severe postmenopausal osteoporosis who need teriparatide treatment,we suggest start teriparatide treatment immediately regardless of the baseline vitamin D level when co-administered with vitamin D.