Open Access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
Author(s) -
Rastogi Ashu,
Hajela Abhishek,
Prakash Mahesh,
Khandelwal Niranjan,
Kumar Rajender,
Bhattacharya Anish,
Mittal Bhagwant R.,
Bhansali Anil,
Armstrong David G.
Publication year - 2019
Publication title -
journal of diabetes
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.949
H-Index - 43
eISSN - 1753-0407
pISSN - 1753-0393
DOI - 10.1111/1753-0407.12902
Subject(s) - medicine , teriparatide , placebo , bone remodeling , bone mineral , urology , parathyroid hormone , osteoporosis , diabetes mellitus , endocrinology , bone density , gastroenterology , surgery , pathology , calcium , alternative medicine
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 (SUV max ) value of 18 F‐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 SUV max g/ml. Results Mid‐foot was the most common region involved. After 12 months, SUV max 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/cm 2 ( P = 0.192) with teriparatide, but decreased by −0.06 ± 0.08 g/cm 2 with placebo ( P = 0.488; intergroup comparison, P = 0.096). Conclusion Teriparatide increases foot bone remodeling by an osteoanabolic action in people with CN.