title: Bisphosphonate Pre-Treatment Diminishes the Therapeutic Benefits of Teriparatide in Japanese Osteoporotic Patients.
abstract: Osteoporosis (OP) is the most common multifactorial metabolic bone disorder worldwide. It remains unclear whether bisphosphonate (BP) pre-treatment affects the anabolic bone metabolism in OP patients treated with teriparatide (TPTD), a recombinant form of parathyroid hormone 1-34. This study is the first to evaluate the clinical outcomes of daily TPTD administration in Japanese OP patients and aimed to clarify how BP pre-treatment influences the efficacy of TPTD. We enrolled 112 patients diagnosed as primary OP who received TPTD. Subjects were classified as OP treatment-naïve patients (TPTD alone group) or patients previously treated with BP (BP pre-treated group). We measured serum bone-specific alkaline phosphatase (BAP) as a bone formation marker, urinary cross-linked N-terminal telopeptide of type I collagen (NTX) as a bone resorption marker, and bone mineral density (BMD) of lumbar vertebrae (L-BMD) and bilateral total hips (H-BMD). In both groups, BAP and NTX increased until 6 months and then decreased thereafter. The percent changes of both markers in BP pre-treated group were more increased than those in TPTD alone group. L-BMD increased significantly in both groups. The percent increase of L-BMD in the TPTD alone group was significantly higher than that in the BP pre-treated group. H-BMD rose significantly in the TPTD alone group, but not in BP pre-treated group. BP pre-treatment appears to diminish the degree of the TPTD-mediated increase in BMD. Thus, it is preferable to administer TPTD ahead of BP treatment in patients with severe OP.
authors.affiliation: Center for Osteoporosis and Spinal Disorders, Kamimura Orthopaedic Clinic.
authors.forename: Mikio
authors.initials: M
authors.lastname: Kamimura
authors.forename: Yukio
authors.initials: Y
authors.lastname: Nakamura
authors.forename: Shota
authors.initials: S
authors.lastname: Ikegami
authors.forename: Shigeharu
authors.initials: S
authors.lastname: Uchiyama
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kato
mesh_terms: D000368:Aged; D015519:Bone Density / Q000187:drug effects*; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D004164:Diphosphonates / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D010024:Osteoporosis / Q000503:physiopathology* / Q000517:prevention & control; D019379:Teriparatide / Q000627:therapeutic use*
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D019379:Teriparatide