title: Effects of teriparatide in postmenopausal women with osteoporosis on prior alendronate or raloxifene: differences between stopping and continuing the antiresorptive agent.
abstract: 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.
authors: Helen Hayes Hospital, West Haverstraw, New York 10993, USA. cosmanf@helenhayeshosp.org
authors: Felicia
authors: F
authors: Cosman
authors: Robert A
authors: RA
authors: Wermers
authors: Christopher
authors: C
authors: Recknor
authors: Karen F
authors: KF
authors: Mauck
authors: Li
authors: L
authors: Xie
authors: Emmett V
authors: EV
authors: Glass
authors: John H
authors: JH
authors: Krege
mesh_terms: 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
chemical_list: D015415:Biomarkers; D050071:Bone Density Conservation Agents; D019379:Teriparatide; D014807:Vitamin D; D020849:Raloxifene Hydrochloride; C097949:1,25-dihydroxyvitamin D; D002118:Calcium; D019386:Alendronate