TY - JOUR
T1 - 合并慢性夏科神经关节病的糖尿病患者使用特立帕肽(重组人甲状旁腺激素[1-34])治疗可改善足骨重塑:一项随机双盲安慰剂对照研究
AU - Rastogi, Ashu
AU - Hajela, Abhishek
AU - Prakash, Mahesh
AU - Khandelwal, Niranjan
AU - Kumar, Rajender
AU - Bhattacharya, Anish
AU - Mittal, Bhagwant R.
AU - Bhansali, Anil
AU - Armstrong, David G.
N1 - Funding Information:
information University HospitalsThe authors thank William Jeffcoate (Nottingham University Hospitals Trust, Nottingham, UK) for his valuable comments and for reviewing the manuscript. The authors also thank Sun Pharmaceuticals, India, for providing teriparatide to the study participants. All authors declare that they have nothing to disclose.
Publisher Copyright:
© 2019 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd
PY - 2019
Y1 - 2019
N2 - Background: Currently, there is no consensus regarding the medical treatment of chronic Charcot neuroarthropathy (CN) of foot, except for effective off-loading. Because tarsal bones are predominantly trabecular, teriparatide may improve the macroarchitecture of foot bones in chronic CN. Methods: People with diabetes and chronic CN were randomized to receive either 20 μg teriparatide or placebo subcutaneous daily for 12 months. Thirty-eight patients were screened and data were analyzed for 20. The maximum standardized uptake (SUVmax) value of 18F-FDG PET/CT the region of interest, bone turnover markers and foot bone mineral density BMD were determined. The primary outcome measure was change in SUVmax g/ml. Results: Mid-foot was the most common region involved. After 12 months, SUVmax increased from 30.6 ± 14.7 to 37.7 ± 18.0 (P = 0.044) in the teriparatide group, but decreased from 27.6 ± 12.2 to 22.9 ± 10.4 with placebo (P = 0.148). The estimated treatment difference (ETD) was 11.9 ± 4.3 (95% CI 2.9, 20.8; P = 0.012). Similarly, P1NP increased with teriparatide (19.8 ± 5.5; P = 0.006) but decreased with placebo (−5.1 ± 3.8 ng/mL; P = 0.219); ETD was 24.8 ± 6.6 (95% CI 10.8, 38.8; P < 0.001) and CTX increased in both the teriparatide and placebo groups. Foot BMD increased by 0.06 ± 0.04 g/cm2 (P = 0.192) with teriparatide, but decreased by −0.06 ± 0.08 g/cm2 with placebo (P = 0.488; intergroup comparison, P = 0.096). Conclusion: Teriparatide increases foot bone remodeling by an osteoanabolic action in people with CN.
AB - Background: Currently, there is no consensus regarding the medical treatment of chronic Charcot neuroarthropathy (CN) of foot, except for effective off-loading. Because tarsal bones are predominantly trabecular, teriparatide may improve the macroarchitecture of foot bones in chronic CN. Methods: People with diabetes and chronic CN were randomized to receive either 20 μg teriparatide or placebo subcutaneous daily for 12 months. Thirty-eight patients were screened and data were analyzed for 20. The maximum standardized uptake (SUVmax) value of 18F-FDG PET/CT the region of interest, bone turnover markers and foot bone mineral density BMD were determined. The primary outcome measure was change in SUVmax g/ml. Results: Mid-foot was the most common region involved. After 12 months, SUVmax increased from 30.6 ± 14.7 to 37.7 ± 18.0 (P = 0.044) in the teriparatide group, but decreased from 27.6 ± 12.2 to 22.9 ± 10.4 with placebo (P = 0.148). The estimated treatment difference (ETD) was 11.9 ± 4.3 (95% CI 2.9, 20.8; P = 0.012). Similarly, P1NP increased with teriparatide (19.8 ± 5.5; P = 0.006) but decreased with placebo (−5.1 ± 3.8 ng/mL; P = 0.219); ETD was 24.8 ± 6.6 (95% CI 10.8, 38.8; P < 0.001) and CTX increased in both the teriparatide and placebo groups. Foot BMD increased by 0.06 ± 0.04 g/cm2 (P = 0.192) with teriparatide, but decreased by −0.06 ± 0.08 g/cm2 with placebo (P = 0.488; intergroup comparison, P = 0.096). Conclusion: Teriparatide increases foot bone remodeling by an osteoanabolic action in people with CN.
KW - Charcot neuroarthropathy
KW - bone mineral density
KW - bone turnover markers
KW - diabetic foot
KW - teriparatide
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U2 - 10.1111/1753-0407.12902
DO - 10.1111/1753-0407.12902
M3 - Article
C2 - 30632290
AN - SCOPUS:85061436205
SN - 1753-0393
VL - 11
SP - 703
EP - 710
JO - Journal of Diabetes
JF - Journal of Diabetes
IS - 9
ER -