Dobnig H, Stepan JJ, Burr DB, Li J, Michalská D, Sipos A, Petto H, Fahrleitner-Pammer A, Pavo I
Teriparatide Reduces Bone Microdamage Accumulation in Postmenopausal Women Previously Treated with Alendronate. [JOURNAL ARTICLE]
J Bone Miner Res 2009 May 19.
Abstract Suppression of bone turnover by bisphosphonates is associated with increased bone microdamage accumulation in animal models. Our objective was to investigate the effects of teriparatide treatment on changes in microdamage accumulation at the iliac crest in previously treatment-naïve patients or in those switched from alendronate to teriparatide. Sixty-six postmenopausal women with osteoporosis (mean age of 68.0 years and mean BMD T-score of -2.8 at lumbar spine and -1.7 at total hip; 62% with prevalent fractures) entered this prospective, non-randomized study and started with 24-months 20 mug/day subcutaneous teriparatide treatment in monotherapy: thirty-eight patients stopped previous alendronate treatment (10 mg/day or 70 mg/week for a mean duration of 63.6 months) and switched to teriparatide while twenty-eight were treatment-naïve previously. Thirty-one paired biopsies with two intact cortices were collected and analyzed for microstructure and microdamage accumulation at baseline and after 24-months of teriparatide administration. Following 24 months of teriparatide treatment, crack density (Cr.Dn), crack surface density (Cr.S.Dn) and crack length (Cr.Le) were decreased in previously alendronate treated patients while only Cr.Le was reduced in former treatment-naive patients. Patients with lower initial femoral neck BMD also demonstrated a higher reduction of microdamage accumulation. Better bone microarchitecture correlated positively while bone turnover markers and age did not correlate with reduced microdamage accumulation on teriparatide. In conclusion, teriparatide reduces microdamage accumulation in the iliac crest of patients previously treated with alendronate. There is insufficient evidence to suggest that age or bone turnover would be associated with this change.
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