Tierärztl. Hochsch., Diss., 2004--Hannover.

Bakgrund: Osteoporos är en sjukdom som kännetecknas av minskad benmassa och försämrad benkvalitet vilket ökar risken för benbrott. Sjukdomen drabbar framför allt äldre kvinnor som passerat menopaus, men även män och yngre personer kan drabbas. Riskfaktorer inkluderar genetik, bristande fysisk aktivitet, rökning, alkoholkonsumtion och vissa sjukdomar och mediciner. Behandling av osteoporos fokuserar på att minska risken för frakturer genom att förbättra benhälsa och minska benförlust. Behandling kan ske med resorptionshämmande läkemedel som bisfosfonater eller denosumab som hämmar nedbrytningen av benmassa eller anabola läkemedel som teriparatid som stimulerar nybildning av benmassa.   Syfte: Syftet med detta litteraturarbete var att beskriva effekten av sekventiell behandling på bone mineral density (BMD) vid behandling med teriparatid följt av denosumab hos kvinnor med svår postmenopausal osteoporos utifrån tidigare studier.  Metod: De fem vetenskapliga artiklar som användes till litteraturstudien togs från databasen PubMed. Dessa analyserades med fokus på hur behandling med teriparatid följt av denosumab påverkar BMD hos kvinnor med svår postmenopausal osteoporos. Resultat: Resultatet visade en signifikant ökning av BMD på ryggraden i samtliga studier vid behandling med teriparatid följt av denosumab. En ökning av BMD kunde även ses på höft och lårbenshals dock var ökningen inte signifikant i alla studier. Frakturrisken studerades i tre av studierna. I en av studierna påvisades en signifikant minskning av frakturrisken vid behndling med teriparatid följt av denosumab, i en annan studie påvisades en minskning av frakturrisken dock var minskningen inte signifikant. I den tredje studien var det en mer fraktur i gruppen som fick teriparatid följt av denosumab.  Slutsats: Observerade data visar att behandling med teriparatid följt av denosumab har bättre effekt på BMD jämfört med monoterapi med denosumab eller teriparatid följt av bisfosfonater. Vidare studierna skulle dock behöva göras då det finns få randomiserade kontrollstudier och studierna som finns har relativt få antal deltagare. Dessutom skulle det behövas studier som pågår under längre perioder för att kunna påvisa eventuella långtidsbivekningar. / Background: Osteoporosis is a disease characterized by reduced bone mass and deteriorated bone quality, which increases the risk of bone fractures. The disease primarily affects older women who have gone through menopause, but men and younger individuals can also be affected. Risk factors include genetics. Lack of physical activity, smoking, alcohol consumtion and certain diseases and medications. Treatment of osteoporosis focuses on reducing the risk of fractures by improving bone health and reducing bone loss. Treatment may involve the use of resorption inhibitors such as bisphosphonates or denosumab, which inhibit the breakdown of bone mass, or anabolic drugs such as teriparatide, which stimulate the formation of new bone mass. Purpose: The purpose of this literature review was to describe the effect of sequential treatment on bone mineral density (BMD) in women with severe postmenopausal osteoporosis who were treated with teriparatide followed by denosumab. Method: The five scientific articles used for the literature review were retrieved from the PubMed database. These were analyzed with focus on how treatment with teriparatide followed by denosumab affects BMD in women with severe postmenopausal osteoporosis. Results: The results showed a significant increase in BMD in the spine in all studies when treated with teriparatid followed by denosumab. An increase in BMD could also be seen in the hip and femoral neck, although the increase was not significant in all studies. Fracture risk was studied in three of the studies. In one of the studies, a significant in fracture risk was demonstarted with treatment with teriparatid followed by denosumab. In another study, a decrease in fracture risk was observed, altough the decrease was not significant. In the third study, there were more fractures in the group that received teriparatid fallowed by denosumab. Conclusion: The observed data indicate that treatment with teriparatide followed by denosumab has a better effect on BMD compared to monotherapy with denosumab or teriparatide followed by bisphosphonates. However, further studies are needed as there are few randomized controll studies and the existing studies have a relatively small number of participants. In addition, studies conducted over longer periodes of time would be necessary to identify potential long-term side effects.

Circadian rhythm of parathyroid hormone (PTH) is well documented, but its physiological role is not fully understood. In healthy individuals, biochemical markers of bone remodeling follow a similar circadian rhythm to PTH with a nocturnal rise in bone resorption and formation. The loss of PTH diurnal variation was observed not only in primary hyperparathyroidism, but also in patients with postmenopausal osteoporosis. Continuously elevated concentrations of PTH lead to excessive stimulation of bone resorption, whereas intermittent PTH administration has a strong osteoanabolic effect in patients with osteoporosis. It has not been examined whether the skeletal sensitivity to PTH action depends also on the time of its application. The aim of our study was to verify the hypothesis that the application of teriparatide (TPTD, recombinant human PTH [1-34]) at different times of the day in the context of its diurnal variability affects the physiological circadian rhythm of bone remodeling and also the bone mineral density (BMD) after the long-term TPTD treatment. Fourteen women with postmenopausal osteoporosis treated with 20 micrograms of TPTD daily, applied subcutaneously either in the morning or evening, were included in the first study. The concentration of serum C-terminal telopeptide of type I collagen...

Circadian rhythm of parathyroid hormone (PTH) is well documented, but its physiological role is not fully understood. In healthy individuals, biochemical markers of bone remodeling follow a similar circadian rhythm to PTH with a nocturnal rise in bone resorption and formation. The loss of PTH diurnal variation was observed not only in primary hyperparathyroidism, but also in patients with postmenopausal osteoporosis. Continuously elevated concentrations of PTH lead to excessive stimulation of bone resorption, whereas intermittent PTH administration has a strong osteoanabolic effect in patients with osteoporosis. It has not been examined whether the skeletal sensitivity to PTH action depends also on the time of its application. The aim of our study was to verify the hypothesis that the application of teriparatide (TPTD, recombinant human PTH [1-34]) at different times of the day in the context of its diurnal variability affects the physiological circadian rhythm of bone remodeling and also the bone mineral density (BMD) after the long-term TPTD treatment. Fourteen women with postmenopausal osteoporosis treated with 20 micrograms of TPTD daily, applied subcutaneously either in the morning or evening, were included in the first study. The concentration of serum C-terminal telopeptide of type I collagen...

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