University of Southern Denmark 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

Summary 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 Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00198-019-05029-z) contains supplementary material, which is available to authorized users. * D. B. Jepsen Ditte.Beck. Jepsen@rsyd.dk J. Ryg Jesper.Ryg@rsyd.dk S. Hansen Stinus.Gadegaard. Hansen@rsyd.dk N. R. Jørgensen Niklas.Rye. Joergensen@regionh.dk J. Gram Jeppe.Gram@rsyd.dk T. Masud Tahir.Masud@nuh.nhs. uk 1 Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark 2 Institute of Clinical Research, University of Southern Denmark, Odense, Denmark 3 Department of Endocrinology, Odense University Hospital, Odense, Denmark 4 Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark 5 OPEN—Odense Patient data Explorative Network, Department of Clinical Research, University of Southern Denmark, Odense, Denmark 6 Department of Endocrinology, Hospital of Southwest Jutland, Esbjerg, Denmark 7 Department of Geriatric Medicine, Nottingham University Hospitals Trust NHS, Nottingham, UK Osteoporosis International (2019) 30:1827–1836 https://doi.org/10.1007/s00198-019-05029-z