Effects of teriparatide in postmenopausal women with osteoporosis on prior alendronate or raloxifene: differences between stopping and continuing the antiresorptive agent.
OBJECTIVE
The aim of the study was to assess adding vs. switching to teriparatide 20 microg/d in patients on alendronate or raloxifene.


METHODS
We conducted a randomized, open-label trial.


METHODS
Postmenopausal women with osteoporosis on alendronate or raloxifene for at least 18 months added teriparatide (Add groups) or switched to teriparatide (Switch groups) for 18 months.


METHODS
We measured bone turnover markers (BTM) and bone mineral density (BMD).


RESULTS
In the alendronate stratum, increases in BTM were smaller in the Add vs. Switch group [6-month PINP (64 vs. 401%); bone ALP (15 vs. 71%); betaCTX (27 vs. 250%); all P < 0.001]. However, at 6 months, total hip BMD increased more in the Add vs. Switch group (1.4 vs. -0.8%; P = 0.002). In the Add vs. Switch group, 18-month BMD increments were higher in lumbar spine (8.4 vs. 4.8%; P = 0.003) and total hip (3.2 vs. 0.9%; P = 0.02), but not in femoral neck (2.7 vs. 2.3%; P = 0.75). In the raloxifene stratum, increases in BTM were also smaller in the Add vs. Switch group [6-month PINP (131 vs. 259%; P < 0.001), bone ALP (31 vs. 44%; P = 0.035), and betaCTX (67 vs. 144%; P = 0.001)]. At 6 months, total hip BMD increase was greater in the Add vs. Switch group (1.8 vs. 0.5%; P = 0.028). At 18 months, increases in lumbar spine (9.2 vs. 8.1%), total hip (2.8 vs. 1.8%), and femoral neck (3.8 vs. 2.2%) were not significantly different between groups.


CONCLUSIONS
In women with osteoporosis treated with antiresorptives, greater bone turnover increases were achieved by switching to teriparatide, whereas greater BMD increases were achieved by adding teriparatide.
Cosman
Felicia
F
Helen Hayes Hospital, West Haverstraw, New York 10993, USA. cosmanf@helenhayeshosp.org
Wermers
Robert A
RA
Recknor
Christopher
C
Mauck
Karen F
KF
Xie
Li
L
Glass
Emmett V
EV
Krege
John H
JH
D000368:Aged; D019386:Alendronate / Q000008:administration & dosage* / Q000009:adverse effects; D015415:Biomarkers / Q000097:blood / Q000652:urine; D015519:Bone Density / Q000187:drug effects*; D050071:Bone Density Conservation Agents / Q000008:administration & dosage* / Q000009:adverse effects; D016723:Bone Remodeling / Q000187:drug effects*; D002118:Calcium / Q000097:blood / Q000652:urine; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000187:drug effects; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000188:drug therapy* / Q000503:physiopathology; D018579:Patient Selection; D020849:Raloxifene Hydrochloride / Q000008:administration & dosage* / Q000009:adverse effects; D019379:Teriparatide / Q000008:administration & dosage* / Q000009:adverse effects; D016896:Treatment Outcome; D014481:United States; D014807:Vitamin D / Q000009:adverse effects / Q000031:analogs & derivatives / Q000097:blood
D015415:Biomarkers; D050071:Bone Density Conservation Agents; D019379:Teriparatide; D014807:Vitamin D; D020849:Raloxifene Hydrochloride; C097949:1,25-dihydroxyvitamin D; D002118:Calcium; D019386:Alendronate