Evaluation of 48-week daily teriparatide treatment with DXA-based hip structure analysis in elderly female patients with rheumatoid arthritis

Main Article Content

Sho Mokuda


   Objectives: The purposes of the present study were to clarify the effects on the structural strength of the femoral neck bones in elderly RA patients being treated with teriparatide.

Methods: Fifty female RA patients were enrolled. We investigated the bone mineral density (BMD) of the lumbar vertebrae and femoral neck, and performed a hip structure analysis (HSA) using dual-energy X-ray absorptiometry (DXA) during a 48-week treatment with teriparatide (20 µg/day).

Results: The mean age was 74.5 years, and the mean duration of RA was 23.0 years. The percent change in the lumbar BMD was +5.8% (mean, 24 weeks, p<0.01) and +8.0% (mean, 48 weeks, p<0.01). On the other hand, there were no statistically significant differences in the femoral neck BMD changes at either 24 or 48 weeks (p=0.72 and p=0.56, respectively). The percentage change from baseline in the buckling ratio of the femoral neck was -16.8% (improve) at 48 weeks (p=0.004), because of cortical thickening. There were no significant differences in the section modulus (SM) or cross-sectional area (CSA).

Conclusions: The femoral neck bone strength increased with teriparatide treatment in elderly female RA patients.

Article Details

How to Cite
MOKUDA, Sho. Evaluation of 48-week daily teriparatide treatment with DXA-based hip structure analysis in elderly female patients with rheumatoid arthritis. Medical Research Archives, [S.l.], n. 3, apr. 2015. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/129>. Date accessed: 07 oct. 2022.
DXA-based hip structure analysis; glucocorticoid; osteoporosis; rheumatoid arthritis; teriparatide.
Research Articles


Amin S, Gabriel SE, Achenbach SJ, Atkinson EJ, Melton LJ 3rd: Are young women and men with rheumatoid arthritis at risk for fragility fractures? A population-based study. J Rheumatol. 2013; 40: 1669-76.

Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS, et al.: The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum. 1988; 31: 315-24.

Beck TJ, Ruff CB, Warden KE, Scott WW Jr, Rao GU: Predicting femoral neck strength from bone mineral data. A structural approach. Invest Radiol. 1990; 25: 6-18.

Bonnick SL, Beck TJ, Cosman F, Hochberg MC, Wang H, de Papp AE: DXA-based hip structural analysis of once-weekly bisphosphonate-treated postmenopausal women with low bone mass. Osteoporos Int. 2009; 20: 911-21.

Boonen S, Marin F, Obermayer-Pietsch B, Simões ME, Barker C, Glass EV, et al.: Effects of previous antiresorptive therapy on the bone mineral density response to two years of teriparatide treatment in postmenopausal women with osteoporosis. J Clin Endocrinol Metab. 2008; 93: 852-60.

Cummings SR, Karpf DB, Harris F, Genant HK, Ensrud K, LaCroix AZ, et al.: Improvement in spine bone density and reduction in risk of vertebral fractures during treatment with antiresorptive drugs. Am J Med. 2002; 112: 281-9.

Ebina K, Hashimoto J, Shi K, Kashii M, Hirao M, Yoshikawa H. Comparison of the effect of 18-month daily teriparatide administration on patients with rheumatoid arthritis and postmenopausal osteoporosis patients. Osteoporos Int. 2014; 25: 2755-65.

Genant HK, Wu CY, van Kuijk C, Nevitt MC: Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res. 1993; 8: 1137-48.

Haugeberg G, Uhlig T, Falch JA, Halse JI, Kvien TK: Bone mineral density and frequency of osteoporosis in female patients with rheumatoid arthritis: results from 394 patients in the Oslo County Rheumatoid Arthritis register. Arthritis Rheum. 2000; 43: 522-30.

Ito M, Sone T, Fukunaga M: Effect of minodronic acid hydrate on hip geometry in Japanese women with postmenopausal osteoporosis. J Bone Miner Metab. 2010; 28: 334-41.

Kanis JA, Melton LJ III, Christiansen C, Johnston CC, Khaltaev N: The diagnosis of osteoporosis. J Bone Miner Res. 1994; 9: 1137-41.

Kaufman JM, Orwoll E, Goemaere S, San Martin J, Hossain A, Dalsky GP, et al.: Teriparatide effects on vertebral fractures and bone mineral density in men with osteoporosis: treatment and discontinuation of therapy. Osteoporos Int. 2005; 16: 510-6.

Li Z, Meredith MP, Hoseyni MS: A method to assess the proportion of treatment effect explained by a surrogate endpoint. Stat Med. 2001; 20: 3175-88.

Martin R, Burr D. Non-invasive measurement of long bone cross-sectional moment of inertia by photon absorptiometry. J Biomech 1984; 17: 195-201.

Neer RM, Arnaud CD, Zanchetta JR, Prince R, Gaich GA, Reginster JY, et al.: Effect of parathyroid hormone (1-34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med. 2001; 344: 1434-41.

Ørstavik RE, Haugeberg G, Mowinckel P, Høiseth A, Uhlig T, Falch JA, et al.: Vertebral deformities in rheumatoid arthritis: a comparison with population-based controls. Arch Intern Med. 2004; 164: 420-5.

Roux C. Osteoporosis in inflammatory joint diseases. Osteoporos Int. 2011; 22: 421-33.

Saag KG, Shane E, Boonen S, Marín F, Donley DW, Taylor KA, et al.: Teriparatide or alendronate in glucocorticoid-induced osteoporosis. N Engl J Med. 2007; 357: 2028-39.

Saag KG, Zanchetta JR, Devogelaer JP, Adler RA, Eastell R, See K, et al.: Effects of teriparatide versus alendronate for treating glucocorticoid-induced osteoporosis: thirty-six-month results of a randomized, double-blind, controlled trial. Arthritis Rheum. 2009; 60: 3346-55.

Sarkar S, Mitlak BH, Wong M, Stock JL, Black DM, Harper KD: Relationships between bone mineral density and incident vertebral fracture risk with raloxifene therapy. J Bone Miner Res. 2002; 17: 1-10.

Takada J, Miki T, Imanishi Y, Nakatsuka K, Wada H, Naka H, et al.: Effects of raloxifene treatment on the structural geometry of the proximal femur in Japanese women with osteoporosis. J Bone Miner Metab. 2010; 28: 561-7.

Takada J, Katahira G, Iba K, Yoshizaki T, Yamashita T: Hip structure analysis of bisphosphonate-treated Japanese postmenopausal women with osteoporosis. J Bone Miner Metab. 2011; 29: 458-65.

Uusi-Rasi K, Semanick LM, Zanchetta JR, Bogado CE, Eriksen EF, Sato M, et al.: Effects of teriparatide [rhPTH (1-34)] treatment on structural geometry of the proximal femur in elderly osteoporotic women. Bone. 2005; 36: 948-58.

van Staa TP, Geusens P, Bijlsma JW, Leufkens HG, Cooper C: Clinical assessment of the long-term risk of fracture in patients with rheumatoid arthritis. Arthritis Rheum. 2006, 54: 3104-12. 

Vis M, Güler-Yüksel M, Lems WF. Can bone loss in rheumatoid arthritis be prevented? Osteoporos Int. 2013; 24: 2541-53.