Background Teriparatide (TPTD) should be followed by an antiresorptive to maximize bone mineral density gain and anti-fracture protection. Infrequent zoledronic acid (ZOL) administration has demonstrated effectiveness. The duration of ZOL effect following TPTD is unknown. Objective To evaluate the effect of ZOL on bone resorption marker in a post-TPTD versus ZOL-alone scenario in osteoporotic patients. Design Retrospective cohort study. Methods Patients treated with TPTD followed by ZOL (TPTD-ZOL) or with a single ZOL infusion were identified in the database of a tertiary referral center. Clinical and laboratory data, including C-terminal telopeptide of type I collagen (CTX) following ZOL treatment, were compared. Results Twenty-six patients (93% women) treated with TPTD-ZOL and 41 with ZOL were comparable in age (median 70.1 versus 69.6 years, p = 0.6) and sex. Timing of CTX measurement post-ZOL was the same, median 1.0 year. CTX was lower following TPTD-ZOL (median 142.1 versus 184.2 pg/mL, p = 0.005). In a multivariable regression model (controlled for baseline characteristics), pretreatment with TPTD strongly predicted CTX <150 pg/mL, 1 year following ZOL (odds ratio = 7.5, 95% CI 1.3-58.1, p = 0.03). In a subgroup with sequential CTX measurements following one ZOL, significantly lower levels persisted in the TPTD-ZOL group for a median of 4.4 years follow-up. Conclusion ZOL-administered sequential to TPTD yielded deeper and more prolonged bone resorption suppression than ZOL alone. Prospective data are needed to confirm whether in a sequential treatment scenario, subsequent ZOL dosing interval should be less frequent.

中文翻译：

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与单独使用唑来膦酸相比，唑来膦酸与特立帕肽连续使用可能会促进对骨吸收的更大抑制。

背景 特立帕肽（TPTD）后应使用抗骨吸收剂，以最大限度地增加骨矿物质密度和抗骨折保护。不频繁施用唑来膦酸 (ZOL) 已被证明是有效的。TPTD 后 ZOL 效应的持续时间尚不清楚。目的 评估骨质疏松患者 TPTD 后与单独使用 ZOL 情况下 ZOL 对骨吸收标志物的影响。设计回顾性队列研究。方法 在三级转诊中心的数据库中确定接受 TPTD 后 ZOL (TPTD-ZOL) 治疗或单次 ZOL 输注治疗的患者。比较了临床和实验室数据，包括 ZOL 治疗后 I 型胶原蛋白 (CTX) 的 C 末端端肽。结果 接受 TPTD-ZOL 治疗的 26 名患者（93% 为女性）和接受 ZOL 治疗的 41 名患者在年龄（中位数 70.1 岁与 69.6 岁，p = 0.6）和性别上相当。ZOL 后 CTX 测量时间相同，中位数为 1.0 年。TPTD-ZOL 后 CTX 较低（中位数 142.1 与 184.2 pg/mL，p = 0.005）。在多变量回归模型（控制基线特征）中，TPTD 预处理强烈预测 ZOL 1 年后 CTX <150 pg/mL（比值比 = 7.5，95% CI 1.3-58.1，p = 0.03）。在一个 ZOL 后连续进行 CTX 测量的亚组中，TPTD-ZOL 组的中位随访时间为 4.4 年，持续显着降低水平。结论 ZOL 联合 TPTD 给药比单独使用 ZOL 产生更深入、更持久的骨吸收抑制。需要前瞻性数据来确认在序贯治疗方案中，后续 ZOL 给药间隔是否应该减少。