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Effects of teriparatide, alendronate, or both in women with postmenopausal osteoporosis.
J Clin Endocrinol Metab. 2010 Apr; 95(4):1838-45.JC

Abstract

CONTEXT

Teriparatide increases both bone formation and bone resorption.

OBJECTIVE

We sought to determine whether combining teriparatide with an antiresorptive agent would alter its anabolic action.

DESIGN AND SETTING

This was a randomized controlled trial conducted in a single university hospital.

PATIENTS AND INTERVENTION

We randomized 93 postmenopausal women with low bone mineral density (BMD) to alendronate 10 mg daily (group 1), teriparatide 40 microg sc daily (group 2), or both (group 3) for 30 months. Teriparatide was begun at month 6.

MAIN OUTCOME MEASURES

BMD of the lumbar spine, proximal femur, proximal radius, and total body was measured by dual-energy x-ray absorptiometry (DXA) every 6 months. Lumbar spine trabecular BMD was measured at baseline and month 30 by quantitative computed tomography. Serum osteocalcin, N-terminal propeptide of type 1 collagen, and N-telopeptide levels were assessed frequently. Women who had at least one repeat DXA scan on therapy were included in the analyses (n = 69).

RESULTS

DXA spine BMD increased more in women treated with teriparatide alone than with alendronate alone (18 +/- 11 vs. 7 +/- 4%; P < 0.001) or both (18+/-11 vs. 12 +/- 9%; P = 0.045). Similarly, femoral neck BMD increased more in women treated with teriparatide alone than with alendronate alone (11 +/- 5 vs. 4 +/- 4%; P < 0.001) or both (11 +/- 5 vs. 3 +/- 5%; P < 0.001). Quantitative computed tomography spine BMD increased 1 +/- 7, 61 +/- 31, and 24 +/- 24% in groups 1, 2, and 3 (P < 0.001 for all comparisons). Serum osteocalcin, N-terminal propeptide of type 1 collagen, and cross-linked N-telopeptides of type I collagen increased more with teriparatide alone than with both (P < 0.001 for each marker).

CONCLUSION

Alendronate reduces the ability of teriparatide to increase BMD and bone turnover in women.

Authors+Show Affiliations

Department of Medicine, Endocrine Unit, Massachusetts General Hospital, Boston, Massachusetts 02114, USA. jfinkelstein@partners.orgNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

20164296

Citation

Finkelstein, Joel S., et al. "Effects of Teriparatide, Alendronate, or Both in Women With Postmenopausal Osteoporosis." The Journal of Clinical Endocrinology and Metabolism, vol. 95, no. 4, 2010, pp. 1838-45.
Finkelstein JS, Wyland JJ, Lee H, et al. Effects of teriparatide, alendronate, or both in women with postmenopausal osteoporosis. J Clin Endocrinol Metab. 2010;95(4):1838-45.
Finkelstein, J. S., Wyland, J. J., Lee, H., & Neer, R. M. (2010). Effects of teriparatide, alendronate, or both in women with postmenopausal osteoporosis. The Journal of Clinical Endocrinology and Metabolism, 95(4), 1838-45. https://doi.org/10.1210/jc.2009-1703
Finkelstein JS, et al. Effects of Teriparatide, Alendronate, or Both in Women With Postmenopausal Osteoporosis. J Clin Endocrinol Metab. 2010;95(4):1838-45. PubMed PMID: 20164296.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of teriparatide, alendronate, or both in women with postmenopausal osteoporosis. AU - Finkelstein,Joel S, AU - Wyland,Jason J, AU - Lee,Hang, AU - Neer,Robert M, Y1 - 2010/02/17/ PY - 2010/2/19/entrez PY - 2010/2/19/pubmed PY - 2010/5/1/medline SP - 1838 EP - 45 JF - The Journal of clinical endocrinology and metabolism JO - J Clin Endocrinol Metab VL - 95 IS - 4 N2 - CONTEXT: Teriparatide increases both bone formation and bone resorption. OBJECTIVE: We sought to determine whether combining teriparatide with an antiresorptive agent would alter its anabolic action. DESIGN AND SETTING: This was a randomized controlled trial conducted in a single university hospital. PATIENTS AND INTERVENTION: We randomized 93 postmenopausal women with low bone mineral density (BMD) to alendronate 10 mg daily (group 1), teriparatide 40 microg sc daily (group 2), or both (group 3) for 30 months. Teriparatide was begun at month 6. MAIN OUTCOME MEASURES: BMD of the lumbar spine, proximal femur, proximal radius, and total body was measured by dual-energy x-ray absorptiometry (DXA) every 6 months. Lumbar spine trabecular BMD was measured at baseline and month 30 by quantitative computed tomography. Serum osteocalcin, N-terminal propeptide of type 1 collagen, and N-telopeptide levels were assessed frequently. Women who had at least one repeat DXA scan on therapy were included in the analyses (n = 69). RESULTS: DXA spine BMD increased more in women treated with teriparatide alone than with alendronate alone (18 +/- 11 vs. 7 +/- 4%; P < 0.001) or both (18+/-11 vs. 12 +/- 9%; P = 0.045). Similarly, femoral neck BMD increased more in women treated with teriparatide alone than with alendronate alone (11 +/- 5 vs. 4 +/- 4%; P < 0.001) or both (11 +/- 5 vs. 3 +/- 5%; P < 0.001). Quantitative computed tomography spine BMD increased 1 +/- 7, 61 +/- 31, and 24 +/- 24% in groups 1, 2, and 3 (P < 0.001 for all comparisons). Serum osteocalcin, N-terminal propeptide of type 1 collagen, and cross-linked N-telopeptides of type I collagen increased more with teriparatide alone than with both (P < 0.001 for each marker). CONCLUSION: Alendronate reduces the ability of teriparatide to increase BMD and bone turnover in women. SN - 1945-7197 UR - https://www.unboundmedicine.com/medline/citation/20164296/Effects_of_teriparatide_alendronate_or_both_in_women_with_postmenopausal_osteoporosis_ L2 - https://academic.oup.com/jcem/article-lookup/doi/10.1210/jc.2009-1703 DB - PRIME DP - Unbound Medicine ER -