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. 2023 Nov 22:14:20420188231213639.
doi: 10.1177/20420188231213639. eCollection 2023.

Zoledronic acid sequential to teriparatide may promote greater inhibition of bone resorption than zoledronic acid alone

Sharon Giveon  1 , Galia Zacay  2   3 , Iris Vered  4   2 , A Joseph Foldes  5 , Liana Tripto-Shkolnik  4   2
Affiliations

Zoledronic acid sequential to teriparatide may promote greater inhibition of bone resorption than zoledronic acid alone

Sharon Giveon et al. Ther Adv Endocrinol Metab. .

Abstract

Background: Teriparatide (TPTD) should be followed by an antiresorptive to maximize bone mineral density gain and anti-fracture protection. Infrequent zoledronic acid (ZOL) administration has demonstrated effectiveness. The duration of ZOL effect following TPTD is unknown.

Objective: To evaluate the effect of ZOL on bone resorption marker in a post-TPTD versus ZOL-alone scenario in osteoporotic patients.

Design: Retrospective cohort study.

Methods: Patients treated with TPTD followed by ZOL (TPTD-ZOL) or with a single ZOL infusion were identified in the database of a tertiary referral center. Clinical and laboratory data, including C-terminal telopeptide of type I collagen (CTX) following ZOL treatment, were compared.

Results: Twenty-six patients (93% women) treated with TPTD-ZOL and 41 with ZOL were comparable in age (median 70.1 versus 69.6 years, p = 0.6) and sex. Timing of CTX measurement post-ZOL was the same, median 1.0 year. CTX was lower following TPTD-ZOL (median 142.1 versus 184.2 pg/mL, p = 0.005). In a multivariable regression model (controlled for baseline characteristics), pretreatment with TPTD strongly predicted CTX <150 pg/mL, 1 year following ZOL (odds ratio = 7.5, 95% CI 1.3-58.1, p = 0.03). In a subgroup with sequential CTX measurements following one ZOL, significantly lower levels persisted in the TPTD-ZOL group for a median of 4.4 years follow-up.

Conclusion: ZOL-administered sequential to TPTD yielded deeper and more prolonged bone resorption suppression than ZOL alone. Prospective data are needed to confirm whether in a sequential treatment scenario, subsequent ZOL dosing interval should be less frequent.

Keywords: anabolic therapy; bisphosphonates; bone resorption; osteoporosis.

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Conflict of interest statement

The authors declare that there is no conflict of interest.

Figures

Figure 1.
Figure 1.
Follow-up CTX levels are significantly lower in patients treated with teriparatide followed by zoledronic acid (TPTD–ZOL) than ZOL alone. Values are presented as number, median [interquartile range]. TPTD, teriparatide; ZOL, zoledronic acid.
See this image and copyright information in PMC

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