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The combined effect of Parathyroid hormone (1-34) and whole-body Vibration exercise in the treatment of postmenopausal OSteoporosis (PaVOS study): a randomized controlled trial.
Osteoporos Int. 2019 Sep; 30(9):1827-1836.OI

Abstract

Treatment effects of combining teriparatide and whole-body vibration exercise (WBV) vs teriparatide alone in twelve months were compared using bone mineral density (BMD), bone microarchitecture, and bone turnover markers. We found an increased effect in lumbar spine BMD by adding WBV to teriparatide in postmenopausal osteoporotic women.

INTRODUCTION

The parathyroid hormone (PTH) analogue teriparatide is an effective but expensive anabolic treatment for osteoporosis. Whole-body vibration exercise (WBV) has been found to stimulate muscle and bone strength in some studies. Animal data demonstrate a beneficial effect on bone when combining PTH with mechanical loading. The aim of this study was to investigate if combining WBV exercise and teriparatide treatment gives additional beneficial effects on bone compared to teriparatide alone in postmenopausal women with osteoporosis.

METHODS

The PaVOS study is a randomized controlled trial where postmenopausal osteoporotic women starting teriparatide 20 μg/day were randomized to WBV + teriparatide or teriparatide alone. WBV consisted of three sessions a week (12 min, including 1:1 ratio of exercise:rest). Bone mineral density (BMD) and bone microarchitecture, bone turnover markers, and sclerostin measurements were obtained. Data were analyzed using a linear mixed regression model with adjustment for baseline values or robust cluster regression in an intention-to-treat (ITT) analysis.

RESULTS

Thirty-five women were randomized (17 in teriparatide + WBV group and 18 in teriparatide group). At 12 months, both groups increased significantly in BMD at the lumbar spine. The teriparatide + WBV group increased by (mean ± SD) 8.90% ± 5.47 and the teriparatide group by 6.65% ± 5.51. The adjusted treatment effect of adding WBV to teriparatide was statistically significant at 2.95% [95% CI = 0.14-5.77; P = 0.040]. Markers of bone turnover increased significantly in both groups at three and six months with no significant difference between groups. No other treatment effects were observed in hip BMD, bone microarchitecture parameters, or sclerostin levels in either group.

CONCLUSION

Twelve months of WBV and teriparatide had a significant clinically relevant treatment effect in lumbar spine BMD compared to teriparatide alone in postmenopausal osteoporotic women. ClinicalTrials.gov :(NCT02563353).

Authors+Show Affiliations

Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark. Ditte.Beck.Jepsen@rsyd.dk. Institute of Clinical Research, University of Southern Denmark, Odense, Denmark. Ditte.Beck.Jepsen@rsyd.dk.Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark. Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.Institute of Clinical Research, University of Southern Denmark, Odense, Denmark. Department of Endocrinology, Odense University Hospital, Odense, Denmark.Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark. OPEN-Odense Patient data Explorative Network, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.Department of Endocrinology, Odense University Hospital, Odense, Denmark. Department of Endocrinology, Hospital of Southwest Jutland, Esbjerg, Denmark.Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark. Institute of Clinical Research, University of Southern Denmark, Odense, Denmark. Department of Geriatric Medicine, Nottingham University Hospitals Trust NHS, Nottingham, UK.

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial

Language

eng

PubMed ID

31309239

Citation

Jepsen, D B., et al. "The Combined Effect of Parathyroid Hormone (1-34) and Whole-body Vibration Exercise in the Treatment of Postmenopausal OSteoporosis (PaVOS Study): a Randomized Controlled Trial." Osteoporosis International : a Journal Established as Result of Cooperation Between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, vol. 30, no. 9, 2019, pp. 1827-1836.
Jepsen DB, Ryg J, Hansen S, et al. The combined effect of Parathyroid hormone (1-34) and whole-body Vibration exercise in the treatment of postmenopausal OSteoporosis (PaVOS study): a randomized controlled trial. Osteoporos Int. 2019;30(9):1827-1836.
Jepsen, D. B., Ryg, J., Hansen, S., Jørgensen, N. R., Gram, J., & Masud, T. (2019). The combined effect of Parathyroid hormone (1-34) and whole-body Vibration exercise in the treatment of postmenopausal OSteoporosis (PaVOS study): a randomized controlled trial. Osteoporosis International : a Journal Established as Result of Cooperation Between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 30(9), 1827-1836. https://doi.org/10.1007/s00198-019-05029-z
Jepsen DB, et al. The Combined Effect of Parathyroid Hormone (1-34) and Whole-body Vibration Exercise in the Treatment of Postmenopausal OSteoporosis (PaVOS Study): a Randomized Controlled Trial. Osteoporos Int. 2019;30(9):1827-1836. PubMed PMID: 31309239.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The combined effect of Parathyroid hormone (1-34) and whole-body Vibration exercise in the treatment of postmenopausal OSteoporosis (PaVOS study): a randomized controlled trial. AU - Jepsen,D B, AU - Ryg,J, AU - Hansen,S, AU - Jørgensen,N R, AU - Gram,J, AU - Masud,T, Y1 - 2019/07/15/ PY - 2019/02/11/received PY - 2019/05/21/accepted PY - 2019/7/17/pubmed PY - 2020/2/11/medline PY - 2019/7/17/entrez KW - postmenopausal osteoporosis KW - randomized controlled trial KW - teriparatide KW - whole-body vibration SP - 1827 EP - 1836 JF - Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA JO - Osteoporos Int VL - 30 IS - 9 N2 - : Treatment effects of combining teriparatide and whole-body vibration exercise (WBV) vs teriparatide alone in twelve months were compared using bone mineral density (BMD), bone microarchitecture, and bone turnover markers. We found an increased effect in lumbar spine BMD by adding WBV to teriparatide in postmenopausal osteoporotic women. INTRODUCTION: The parathyroid hormone (PTH) analogue teriparatide is an effective but expensive anabolic treatment for osteoporosis. Whole-body vibration exercise (WBV) has been found to stimulate muscle and bone strength in some studies. Animal data demonstrate a beneficial effect on bone when combining PTH with mechanical loading. The aim of this study was to investigate if combining WBV exercise and teriparatide treatment gives additional beneficial effects on bone compared to teriparatide alone in postmenopausal women with osteoporosis. METHODS: The PaVOS study is a randomized controlled trial where postmenopausal osteoporotic women starting teriparatide 20 μg/day were randomized to WBV + teriparatide or teriparatide alone. WBV consisted of three sessions a week (12 min, including 1:1 ratio of exercise:rest). Bone mineral density (BMD) and bone microarchitecture, bone turnover markers, and sclerostin measurements were obtained. Data were analyzed using a linear mixed regression model with adjustment for baseline values or robust cluster regression in an intention-to-treat (ITT) analysis. RESULTS: Thirty-five women were randomized (17 in teriparatide + WBV group and 18 in teriparatide group). At 12 months, both groups increased significantly in BMD at the lumbar spine. The teriparatide + WBV group increased by (mean ± SD) 8.90% ± 5.47 and the teriparatide group by 6.65% ± 5.51. The adjusted treatment effect of adding WBV to teriparatide was statistically significant at 2.95% [95% CI = 0.14-5.77; P = 0.040]. Markers of bone turnover increased significantly in both groups at three and six months with no significant difference between groups. No other treatment effects were observed in hip BMD, bone microarchitecture parameters, or sclerostin levels in either group. CONCLUSION: Twelve months of WBV and teriparatide had a significant clinically relevant treatment effect in lumbar spine BMD compared to teriparatide alone in postmenopausal osteoporotic women. ClinicalTrials.gov :(NCT02563353). SN - 1433-2965 UR - https://www.unboundmedicine.com/medline/citation/31309239/The_combined_effect_of_Parathyroid_hormone__1_34__and_whole_body_Vibration_exercise_in_the_treatment_of_postmenopausal_OSteoporosis__PaVOS_study_:_a_randomized_controlled_trial_ L2 - https://doi.org/10.1007/s00198-019-05029-z DB - PRIME DP - Unbound Medicine ER -