title: Effects of morning vs. evening teriparatide injection on bone mineral density and bone turnover markers in postmenopausal osteoporosis.
abstract: A 12-month morning teriparatide (TPTD) administration resulted in a larger increase in the lumbar spine bone mineral density (BMD) than the evening application. The results indicate that the response of bone cells to teriparatide treatment depends on dosing time.
  
  
  BACKGROUND
  The aim of this study was to assess the long-term effects of the morning vs. the evening teriparatide administration on BMD and bone turnover markers (BTMs) in postmenopausal osteoporosis.
  
  
  METHODS
  Fifty women with established postmenopausal osteoporosis were randomized to 12-month treatment with 20 μg of TPTD, administered daily in the morning or in the evening. The BMD and serum concentrations of C-terminal telopeptide of type I collagen, N-terminal propeptide of type I procollagen (PINP), and tartrate-resistant acid phosphatase isoform 5b (TRAP 5b) were measured at baseline, after 6 and 12 months. General linear model-repeated measurements were used to analyze the data.
  
  
  RESULTS
  After 12 months, the lumbar spine BMD grew markedly (p < 0.001) with a significantly greater increase in the morning arm compared to the evening arm (9.1% vs. 4.8%, respectively, p < 0.05). The BMD at the distal radius significantly decreased (p < 0.001), with no differences between the arms. The BMD at proximal femur did not change significantly. After 6 months, the BTMs were significantly increased compared with baseline (p < 0.001). The increases in the evening arm vs. the morning arm, however, were more pronounced in PINP (+358% vs. +215%, respectively) and in TRAP 5b (+70% vs. +37%, respectively) (both p < 0.05).
  
  
  CONCLUSIONS
  12-month morning administration of TPTD resulted in a larger increase in the lumbar spine BMD than the evening application. The timing of TPTD administration may be important for its efficacy.
authors.affiliation: Department of Internal Medicine III-Department of Endocrinology and Metabolism, General University Hospital and First Faculty of Medicine, Charles University, Prague, U Nemocnice 1, 128 08, Prague 2, Czech Republic.
authors.forename: D
authors.initials: D
authors.lastname: Michalska
authors.forename: M
authors.initials: M
authors.lastname: Luchavova
authors.forename: V
authors.initials: V
authors.lastname: Zikan
authors.forename: I
authors.initials: I
authors.lastname: Raska
authors.forename: A A
authors.initials: AA
authors.lastname: Kubena
authors.forename: J J
authors.initials: JJ
authors.lastname: Stepan
mesh_terms: D000135:Acid Phosphatase / Q000097:blood; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D015519:Bone Density / Q000187:drug effects; D050071:Bone Density Conservation Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D002118:Calcium / Q000097:blood; D024042:Collagen Type I / Q000097:blood; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007279:Injections, Subcutaneous; D007527:Isoenzymes / Q000097:blood; D008159:Lumbar Vertebrae / Q000503:physiopathology; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D010446:Peptide Fragments / Q000097:blood; D010455:Peptides / Q000097:blood; D010710:Phosphates / Q000097:blood; D011347:Procollagen / Q000097:blood; D000071681:Tartrate-Resistant Acid Phosphatase; D019379:Teriparatide / Q000008:administration & dosage* / Q000627:therapeutic use
chemical_list: D015415:Biomarkers; D050071:Bone Density Conservation Agents; D024042:Collagen Type I; D007527:Isoenzymes; D010446:Peptide Fragments; D010455:Peptides; D010710:Phosphates; D011347:Procollagen; C052929:collagen type I trimeric cross-linked peptide; C047202:procollagen Type I N-terminal peptide; D019379:Teriparatide; D000135:Acid Phosphatase; D000071681:Tartrate-Resistant Acid Phosphatase; D002118:Calcium