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Teriparatide reduced fracture risk, and in a published CAL-101 molecular weight meta-analysis of clinical trials, teriparatide-treated patients had a reduced incidence of back pain relative to a placebo and antiresorptive drugs [22, 23]. Patients randomized to teriparatide had a reduced risk of new or worsening back pain compared with patients randomized to a placebo, hormone replacement therapy, or alendronate [23]. Patients with osteoporosis treated with antiresorptive and anabolic agents, particularly those with teriparatide therapy, had a reduced risk of new or worsening back pain. Fewer patients treated with teriparatide reported

new or worsening back pain, especially moderate and severe back pain, compared with those SBI-0206965 supplier treated with alendronate [13, 24]. Teriparatide was more effective than other drugs in

reducing back pain and improving the quality of life of LY411575 purchase postmenopausal osteoporotic women with VCFs [25]. The mechanism of back pain reduction likely includes a reduction in both severity and number of new VCFs [26] and improvement in bone microarchitecture and quality [13]. The VAS and JOA low back pain scores were significantly better after 6 months of treatment. After 6 months, the VAS continued to decrease, and the JOA score continued to increase; the difference between group A and group B was statistically significant at 12 and 18 months

of treatment (p < 0.001). Some biomechanical test data and clinical studies have suggested patients who undergo vertebroplasty or kyphoplasty had a greater risk of new VCFs compared with patients with prior VCFs who did not undergo either procedure [4]. Biomechanical test data demonstrated that fractured vertebrae treated with bone cement are stiffer than untreated vertebrae, and thus could transfer a greater load to adjacent vertebral levels [27, 28]. An increased fracture rate of the adjacent vertebrae has been observed after vertebroplasty [8]. Sitaxentan Specifically, following vertebroplasty, patients are at increased risk of new-onset adjacent-level fractures and, when these fractures occur, they occur much sooner than non-adjacent-level fractures [6, 8]. Antiresorptive agents (alendronate, risedronate, raloxifene, and calcitonin) are widely used to treat osteoporosis. In a randomized trial of daily therapy with raloxifene for 24 months, the mean difference in the change in BMD between the women receiving 60 mg of raloxifene per day and those receiving a placebo was 2.4% ± 0.4% for the lumbar spine, 2.4% ± 0.4% for the total hip, and 2.0% ± 0.4% for the total body [29]. Treatment with 10 mg of alendronate daily for 10 years produced mean increases in BMD of 13.7% at the lumbar spine [30].

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