Pro-Remodeling Effect of Teriparatide Therapy is Associated with Loss of Cortical Mass at the Hip in the STRUCTURE Study
Bibliographic record
Abstract
Introduction: Romosozumab, a sclerostin monoclonal antibody, increases bone formation and decreases bone resorption, while teriparatide increases both formation and resorption. STRUCTURE (NCT01796301) reported greater gains in bone mineral density (BMD) at spine and hip with romosozumab versus teriparatide. Using quantitative computed tomography (QCT), hip cortical BMD and content (BMC) declined with teriparatide (1), which may result from increased bone resorption. Methods: 436 women with postmenopausal osteoporosis transitioning from oral bisphosphonates received subcutaneous romosozumab 210 mg once monthly or teriparatide 20 µg once daily for 12 months (m). Cortical BMD and BMC were assessed by QCT at the hip. Serum procollagen type 1 N-telopeptide (P1NP) and type 1 collagen C-telopeptide (CTX) were measured at intervals up to 12 m. The association between area under the curve (AUC) of the change in bone turnover markers and cortical hip BMD/BMC was assessed. Results: Mean baseline BMD T-score was -2.24 (total hip), -2.85 (lumbar spine); 90.4% received alendronate (mean 5.6 years) before screening. At 12 m, hip cortical BMD and BMC increased from baseline by 1.1% and 2.9% in the romosozumab group and decreased with teriparatide (-3.6% and -1.3%, respectively; p < 0.0001, romosozumab vs. teriparatide). With romosozumab, CTX decreased, returning to and remaining at baseline after 3 m. With teriparatide, CTX increased and remained above baseline for 12 m; hip cortical BMD/BMC decrease correlated with CTX AUC increase (r =-0.47 and -0.38 respectively, p < 0.0001). Discussion: The bone resorption increase following teriparatide correlated with the reduction in hip cortical BMD/BMC, suggesting that the pro-remodeling action of teriparatide can have a negative effect on cortical bone over 12 months. As romosozumab increases bone formation while decreasing bone resorption with rapid gains in hip cortical BMD/BMC, it may offer therapeutic advantages for patients at high risk of hip fracture. *LM: Presenting on behalf of the authorship group. Reference: 1. Langdahl et al, EULAR 2016
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".