Session Type: Abstract Submissions (ACR)
Rheumatoid arthritis (RA) decreases bone mineral density and bone quality, and exposes patients to an increased risk of fracture. In RA treatment, improvement of systemic osteoporosis using anti-osteoporotic agents is important, as is suppression of fracture risk by controlling inflammation with a combination of disease-modifying anti-rheumatic drugs or biological agents. However, few studies have examined the effects of anti-osteoporosis drugs on patients with RA. Therefore, this study quantitatively evaluated the effects of daily teriparatide (TPTD) in RA patients at high risk of fracture after 6 months using several methods.
A total of 30 RA patients were enrolled in this prospective study. All patients receiving TPTD were evaluated according to changes in two bone turnover markers from baseline to 1, 3, and 6 months. The markers used were serum procollagen type 1 N-terminal propeptide (P1NP) and tartrate-resistant acid phosphatase-5b (TRACP-5b). Assessments were also made according to bone mineral density (BMD) by dual x-ray absorptiometry (DXA) and bone strength by quantitative computed tomography (CT) at baseline. Reevaluation was performed after 6 months. Nonlinear finite element analysis (FEA) was performed on CT to estimate spinal and femoral predicted bone strength (PBS). We adopted two loading conditions, stance and fall configurations, on femoral PBS.
Patients were 67.7±8.2 years old and the duration of symptoms was 12.2±10.7 years. The majority of subjects showed moderate disease activity (mean baseline 28-joint Disease Activity Score, 3.0±1.3). Mean values at baseline and at 1, 3, and 6 months were 42 μg/L, 141 μg/L, 144 μg/L and 153 μg/L for PINP, and 423 mU/dL, 527 mU/dL, 583 mU/dL and 601 mU/dL for TRACP-5b. Patients had significantly greater levels of serum PINP and TRACP-5b (p<0.05 compared with baseline) at all points measured. Mean values at baseline and at 6 months were 0.89 g/cm2 and 0.94 g/cm2 (p<0.01) for BMD-spine (median change 6.1%), 0.62 g/cm2 and 0.63 g/cm2 (p=0.31) for BMD-femoral neck (median change, 1.1%), 3584 N and 3971 N (p<0.01) for PBS-spine (mean change 12.1%), 4146 N and 4194 N (p=0.3) for femoral PBS-stance (mean change 1.9%) and 1485 N and 1504 N (p=0.2) for femoral PBS-fall (mean change, 1.9%) (Fig. 1).
Our results show that TPTD can increase BMD and FEA on RA patients, and bone loss in patients with RA can be prevented by TPTD. FEA appears to detect the effects of TPTD more sensitively than DXA. We will have to follow these effects in the longer term.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/effects-of-daily-teriparatide-on-the-spine-and-femoral-strength-assessed-by-finite-element-analysis-of-clinical-computed-tomography-in-rheumatoid-arthritis-patients/