Early responsiveness of women with osteoporosis to teriparatide after therapy with alendronate or risedronate.
BACKGROUND
Anabolic responsiveness to teriparatide can be blunted or delayed in patients previously treated with alendronate. The extent of this effect is different for other antiresorptives. This study evaluated the early anabolic effects of teriparatide in postmenopausal women with osteoporosis previously treated with alendronate or risedronate.


METHODS
Patients treated for at least 24 months with alendronate or risedronate discontinued their bisphosphonate and received teriparatide for 12 months. The primary endpoint was a comparison of changes from baseline in N-terminal propeptide of type 1 collagen after 3 months between prior bisphosphonate groups. We also examined changes in other bone turnover markers, bone mineral density (BMD), and relationships between early changes in bone turnover markers and 12-month areal and volumetric BMD.


RESULTS
In the prior risedronate group, the N-terminal propeptide of type 1 collagen increase was significantly greater after 3 months of teriparatide than in the prior alendronate group (mean +/- se, 86.0 +/- 5.6 vs. 61.2 +/- 5.3 ng/ml, respectively; P < 0.001). Findings were similar for the other bone turnover markers. The changes in areal BMD and trabecular spine volumetric BMD were also greater in the prior risedronate group (P < 0.05). Early changes in bone turnover markers correlated with changes in trabecular spine volumetric BMD at 12 months (Spearman r = 0.45). Teriparatide was well tolerated.


CONCLUSIONS
This nonrandomized but prospective study suggests that there may be differences in anabolic responsiveness to teriparatide as a function of the type of prior bisphosphonate exposure.
Miller
Paul D
PD
Colorado Center for Bone Research, Lakewood, Colorado 80227, USA. MillerCCBR@aol.com
Delmas
Pierre D
PD
Lindsay
Robert
R
Watts
Nelson B
NB
Luckey
Marjorie
M
Adachi
Jonathan
J
Saag
Kenneth
K
Greenspan
Susan L
SL
Seeman
Ego
E
Boonen
Steven
S
Meeves
Suzanne
S
Lang
Thomas F
TF
Bilezikian
John P
JP
D000368:Aged; D000369:Aged, 80 and over; D019386:Alendronate / Q000627:therapeutic use*; D000465:Algorithms; D045930:Anabolic Agents / Q000494:pharmacology / Q000627:therapeutic use; D050071:Bone Density Conservation Agents / Q000009:adverse effects / Q000627:therapeutic use; D016723:Bone Remodeling / Q000187:drug effects; D017024:Chemotherapy, Adjuvant; D004351:Drug Resistance / Q000187:drug effects; D012968:Etidronic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000188:drug therapy* / Q000378:metabolism; D000068296:Risedronic Acid; D019379:Teriparatide / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome
D045930:Anabolic Agents; D050071:Bone Density Conservation Agents; D019379:Teriparatide; D000068296:Risedronic Acid; D012968:Etidronic Acid; D019386:Alendronate