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Controlled Clinical Trial
. 2008 Oct;93(10):3785-93.
doi: 10.1210/jc.2008-0353. Epub 2008 Aug 5.

Early responsiveness of women with osteoporosis to teriparatide after therapy with alendronate or risedronate

Paul D Miller  1 , Pierre D Delmas, Robert Lindsay, Nelson B Watts, Marjorie Luckey, Jonathan Adachi, Kenneth Saag, Susan L Greenspan, Ego Seeman, Steven Boonen, Suzanne Meeves, Thomas F Lang, John P Bilezikian; Open-label Study to Determine How Prior Therapy with Alendronate or Risedronate in Postmenopausal Women with Osteoporosis Influences the Clinical Effectiveness of Teriparatide Investigators
Collaborators, Affiliations
Controlled Clinical Trial

Early responsiveness of women with osteoporosis to teriparatide after therapy with alendronate or risedronate

Paul D Miller et al. J Clin Endocrinol Metab. 2008 Oct.

Abstract

Background: Anabolic responsiveness to teriparatide can be blunted or delayed in patients previously treated with alendronate. The extent of this effect is different for other antiresorptives. This study evaluated the early anabolic effects of teriparatide in postmenopausal women with osteoporosis previously treated with alendronate or risedronate.

Methods: Patients treated for at least 24 months with alendronate or risedronate discontinued their bisphosphonate and received teriparatide for 12 months. The primary endpoint was a comparison of changes from baseline in N-terminal propeptide of type 1 collagen after 3 months between prior bisphosphonate groups. We also examined changes in other bone turnover markers, bone mineral density (BMD), and relationships between early changes in bone turnover markers and 12-month areal and volumetric BMD.

Results: In the prior risedronate group, the N-terminal propeptide of type 1 collagen increase was significantly greater after 3 months of teriparatide than in the prior alendronate group (mean +/- se, 86.0 +/- 5.6 vs. 61.2 +/- 5.3 ng/ml, respectively; P < 0.001). Findings were similar for the other bone turnover markers. The changes in areal BMD and trabecular spine volumetric BMD were also greater in the prior risedronate group (P < 0.05). Early changes in bone turnover markers correlated with changes in trabecular spine volumetric BMD at 12 months (Spearman r = 0.45). Teriparatide was well tolerated.

Conclusion: This nonrandomized but prospective study suggests that there may be differences in anabolic responsiveness to teriparatide as a function of the type of prior bisphosphonate exposure.

Trial registration: ClinicalTrials.gov NCT00130403.

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Figures

F<sc>ig</sc>. 1.
Fig. 1.
Screening, enrollment, and analysis populations.
F<sc>ig</sc>. 2.
Fig. 2.
Comparison of bone turnover marker changes from baseline (completer population). A, P1NP mean change from baseline, controlling for prior bisphosphonate group, stratum for duration of prior therapy, and pooled site. B, P1NP ratio to baseline, controlling for prior bisphosphonate group, stratum for duration of prior therapy, and pooled site. *, P < 0.05; **, P < 0.01; ***, P < 0.001. ALN, Alendronate; RIS, risedronate.
F<sc>ig</sc>. 3.
Fig. 3.
Comparison of BMD changes from baseline (BL) (completer population). A, DXA of the lumbar spine, percent change from baseline. B, DXA of the total hip, percent change from baseline. C, QCT of the integral and trabecular spine, percent change from baseline. D, QCT of the integral and trabecular total and trochanteric hip, percent change from baseline. *, P < 0.05; **, P < 0.01. ALN, Alendronate; RIS, risedronate.
See this image and copyright information in PMC

References

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