Objectives: Once-weekly teriparatide (W-TPTD) is an effective drug for patients with osteoporosis; however, some patients discontinue W-TPTD owing to its adverse drug reactions (ADRs). Sequential treatment with W-TPTD and antiresorptive therapy may be effective in treating such patients. In this study, we evaluate the efficacy of this sequential treatment regimen. Methods: This retrospective study was conducted at a single institution in Japan. The target subjects were patients with osteoporosis who started W-TPTD treatment. The subjects who received W-TPTD for 6 months or more were divided into 3 groups: TTT (W-TPTD for 18 months); TBT (sequential treatment of W-TPTD/bisphosphonates/W-TPTD; each for 6 months); and TET (sequential treatment of W-TPTD/ elcatonin/W-TPTD, each for 6 months) groups. The efficacy endpoints were bone mineral densities (BMD) in the lumbar spine and femur. Results: Lumbar spine BMD in group TBT increased significantly by 1.6% (P ¼ 0.023), 2.9% (P ¼ 0.001), and 4.4% (P < 0.001) after 6, 12, and 18 months, respectively, compared with baseline values. In group TET, it increased by 2.1%, (P ¼ 0.001), 1.3% (P ¼ 0.066), and 3.0% (P ¼ 0.015) after 6, 12, and 18 months, respectively. A significant increase was observed only after 6 and 18 months. In group TTT, it increased significantly by 3.3% (P ¼ 0.023), 5.1% (P ¼ 0.019), and 7.1% (P ¼ 0.010) after 6, 12, and 18 months, respectively. However, no significant difference in total hip BMD was observed among all three groups. No serious ADRs were reported. Conclusion In patients who discontinue treatment withW-TPTD due to ADRs, sequential treatment with W-TPTD and antiresorptive therapy would be beneficial.

Objectives: Once-weekly teriparatide (W-TPTD) is an effective drug for patients with osteoporosis; however, some patients discontinue W-TPTD owing to its adverse drug reactions (ADRs). Sequential treatment with W-TPTD and antiresorptive therapy may be effective in treating such patients. In this study, we evaluate the efficacy of this sequential treatment regimen. Methods: This retrospective study was conducted at a single institution in Japan. The target subjects were patients with osteoporosis who started W-TPTD treatment. The subjects who received W-TPTD for 6 months or more were divided into 3 groups: TTT (W-TPTD for 18 months); TBT (sequential treatment of W-TPTD/bisphosphonates/W-TPTD; each for 6 months); and TET (sequential treatment of W-TPTD/ elcatonin/W-TPTD, each for 6 months) groups. The efficacy endpoints were bone mineral densities (BMD) in the lumbar spine and femur. Results: Lumbar spine BMD in group TBT increased significantly by 1.6% (P ¼ 0.023), 2.9% (P ¼ 0.001), and 4.4% (P < 0.001) after 6, 12, and 18 months, respectively, compared with baseline values. In group TET, it increased by 2.1%, (P ¼ 0.001), 1.3% (P ¼ 0.066), and 3.0% (P ¼ 0.015) after 6, 12, and 18 months, respectively. A significant increase was observed only after 6 and 18 months. In group TTT, it increased significantly by 3.3% (P ¼ 0.023), 5.1% (P ¼ 0.019), and 7.1% (P ¼ 0.010) after 6, 12, and 18 months, respectively. However, no significant difference in total hip BMD was observed among all three groups. No serious ADRs were reported. Conclusion In patients who discontinue treatment withW-TPTD due to ADRs, sequential treatment with W-TPTD and antiresorptive therapy would be beneficial.

Background: Taking a good history is important for the diagnosis of abdominal pain. We investigated questionnaire items that were significantly correlated with causes of abdominal pain requiring hospitalization. We also studied the combination of responses that could exclude severe disease.
Method: Between February 2006 and December 2007, 296 of 317 patients with abdominal pain who attended our Outpatient Department completed a questionnaire for their abdominal pain. They included 32 patients requiring hospitalization (severe group) and 264 other patients (mild group). The percentage of positive responses to each questionnaire item was compared between the two groups, and those showing a significant difference were employed for logistic regression analysis.
Results: The following 4 responses were selected: “It is less than 7 days since the onset of pain” (odds ratio [OR], 2.8; 95% confidence interval [95% CI], 1.2-6.4); “The pain is exacerbated by walking” (OR, 2.8; 95% CI, 1.3-6.2); “The pain is accompanied by weight loss” (OR, 3.8; 95% CI, 1.5-9.8); and “The pain wakes me at night” (OR, 2.3; 95% CI, 1.1-5.2). If a patient had none of these responses, the predictive value was 0.03 for severe disease.
Conclusions: Our findings suggested that pain reported within 7 days, exacerbation by walking, nocturnal awakening, and associated weight loss are features of abdominal pain that predict severe disease. Conversely, severe disease can be almost completely excluded in patients negative for all 4 features.