Bone formation markers in patients with glucocorticoid-induced osteoporosis treated with teriparatide or alendronate.
Reduced osteoblast function is a primary defect in glucocorticoid-induced osteoporosis (GIO), and is reflected by decreased biochemical markers of bone formation, such as serum osteocalcin (OC) and procollagen type I N-terminal propeptide (PINP). This analysis compared the effects of teriparatide and alendronate on OC and PINP in patients with GIO. In a double-blind study, women (N=159) and men (N=38) with GIO were randomized to either teriparatide 20 mug/day by subcutaneous injection or to alendronate 10 mg/day orally. OC and PINP were measured in fasting-state serum samples obtained at baseline and at 1, 6, 18, and 36 months. Baseline bone formation markers were below the reference interval (low) in 33% of patients for OC and in 4% of patients for PINP. On teriparatide therapy, the median OC and PINP levels increased by 92% and 108%, respectively, and this resulted in only 12% and 1% of patients being low at 6 months. On alendronate therapy, the median OC and PINP levels decreased by 40% and 53%, respectively, and this resulted in 68% and 34% of patients being low at 6 months. We conclude that bone formation as determined by surrogate markers was increased in teriparatide-treated patients with GIO and decreased in alendronate-treated patients with GIO.
Eastell
Richard
R
University of Sheffield Bone Metabolism Group, Metabolic Bone Centre, Sorby Wing, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK. r.eastell@sheffield.ac.uk
Chen
Peiqi
P
Saag
Kenneth G
KG
Burshell
Alan L
AL
Wong
Mayme
M
Warner
Margaret R
MR
Krege
John H
JH
D000328:Adult; D000368:Aged; D019386:Alendronate / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D015519:Bone Density / Q000187:drug effects / Q000502:physiology; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D016009:Chi-Square Distribution; D004311:Double-Blind Method; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015675:Osteocalcin / Q000097:blood; D010012:Osteogenesis / Q000187:drug effects / Q000502:physiology*; D010024:Osteoporosis / Q000139:chemically induced / Q000188:drug therapy* / Q000378:metabolism*; D010446:Peptide Fragments / Q000097:blood; D011347:Procollagen / Q000097:blood; D019379:Teriparatide / Q000627:therapeutic use*; D016896:Treatment Outcome
D015415:Biomarkers; D050071:Bone Density Conservation Agents; D005938:Glucocorticoids; D010446:Peptide Fragments; D011347:Procollagen; C047202:procollagen Type I N-terminal peptide; D015675:Osteocalcin; D019379:Teriparatide; D019386:Alendronate