Interim data presented previously in abstract form at the 24th Annual Meeting of the American Soceity for Bone and Mineral Research, San Antonio, Texas, USA, September 20-24, 2002, and the 25th Annual Meeting of the American Society for Bone and Mineral Research, Minneapolis, Minnesota, USA, September 19-23, 2003. Dr Ettinger has received grants from Merck and has received grants and served as a consultant for Berlex, Eli Lilly and Company, and Procter & Gamble. Drs San Martin, Crans, and Pavo are employees of Eli Lilly and Company.
Differential Effects of Teriparatide on BMD After Treatment With Raloxifene or Alendronate†
Version of Record online: 19 JAN 2004
Copyright © 2004 ASBMR
Journal of Bone and Mineral Research
Volume 19, Issue 5, pages 745–751, May 2004
How to Cite
Ettinger, B., Martin, S. J., Crans, G. and Pavo, I. (2004), Differential Effects of Teriparatide on BMD After Treatment With Raloxifene or Alendronate. J Bone Miner Res, 19: 745–751. doi: 10.1359/jbmr.040117
- Issue online: 2 DEC 2009
- Version of Record online: 19 JAN 2004
- Manuscript Accepted: 16 JAN 2004
- Manuscript Revised: 2 DEC 2003
- Manuscript Received: 15 OCT 2003
- parathyroid hormone;
- selective estrogen receptor modulators
We investigated the effects of 18 months of treatment with teriparatide in patients previously treated with long-term antiresorptive therapy using bone turnover markers and bone densitometry. Previous raloxifene treatment allowed for teriparatide-induced early bone marker and BMD increases comparable with previously published results for treatment-naïve patients. Conversely, previous alendronate treatment reduced the bone marker and BMD response.
Introduction: Teriparatide [rhPTH(1–34)] has been shown to increase BMD and reduce the risk of fracture in postmenopausal women with osteoporosis. Our objective was to investigate the skeletal effects of 18 months of treatment with teriparatide in women whose osteoporosis was previously treated with either alendronate or raloxifene.
Materials and Methods: Daily subcutaneous injections of 20 μg teriparatide were administered for 18 months to 59 postmenopausal women, 60–87 years of age, with BMD T-scores ≤ −2.0 who had previously received either alendronate (ALN) or raloxifene (RLX) therapy for 18–36 months. All patients received daily calcium (1000 mg) and vitamin D (400 IU) supplementation. The primary study outcome was change in lumbar spine BMD measured by DXA. Secondary outcomes included changes in bone turnover markers, total hip BMD, and safety.
Results: Median baseline bone turnover marker levels in prior ALN patients were about one-half those of prior RLX patients. During teriparatide treatment, bone markers in prior ALN patients increased later and peaked at about one-third lower levels compared with prior RLX patients. During the first 6 months, there were statistically significant (p < 0.05) group differences in BMD change at the hip (prior ALN −1.8% versus prior RLX +0.5%) and at the spine (prior ALN +0.5% versus prior RLX +5.2%). The positive slopes in hip and lumbar spine BMD were similar in both groups between 6 and 18 months. After 18 months, mean lumbar spine BMD increased 10.2% in prior RLX compared with 4.1% in prior ALN (p < 0.05) patients. Furthermore, at 18 months, mean total hip BMD had significantly increased (1.8%, p < 0.05) in prior RLX patients but was not different from baseline in prior ALN patients.
Conclusions: Teriparatide treatment stimulates bone turnover in patients pretreated with both RLX and ALN. Prior treatment with RLX allows for the expected teriparatide-induced BMD increases comparable with those previously reported for treatment-naïve patients. In contrast, prior treatment with ALN prevents increases in BMD, particularly in the first 6 months.