Effects of teriparatide, alendronate, or both in women with postmenopausal osteoporosis

Abstract

Context: Teriparatide increases both bone formation and bone resorption.

Objective: We sought to determine whether combining teriparatide with an antiresorptive agent would alter its anabolic action.

Design and setting: This was a randomized controlled trial conducted in a single university hospital.

Patients and intervention: We randomized 93 postmenopausal women with low bone mineral density (BMD) to alendronate 10 mg daily (group 1), teriparatide 40 microg sc daily (group 2), or both (group 3) for 30 months. Teriparatide was begun at month 6.

Main outcome measures: BMD of the lumbar spine, proximal femur, proximal radius, and total body was measured by dual-energy x-ray absorptiometry (DXA) every 6 months. Lumbar spine trabecular BMD was measured at baseline and month 30 by quantitative computed tomography. Serum osteocalcin, N-terminal propeptide of type 1 collagen, and N-telopeptide levels were assessed frequently. Women who had at least one repeat DXA scan on therapy were included in the analyses (n = 69).

Results: DXA spine BMD increased more in women treated with teriparatide alone than with alendronate alone (18 +/- 11 vs. 7 +/- 4%; P < 0.001) or both (18+/-11 vs. 12 +/- 9%; P = 0.045). Similarly, femoral neck BMD increased more in women treated with teriparatide alone than with alendronate alone (11 +/- 5 vs. 4 +/- 4%; P < 0.001) or both (11 +/- 5 vs. 3 +/- 5%; P < 0.001). Quantitative computed tomography spine BMD increased 1 +/- 7, 61 +/- 31, and 24 +/- 24% in groups 1, 2, and 3 (P < 0.001 for all comparisons). Serum osteocalcin, N-terminal propeptide of type 1 collagen, and cross-linked N-telopeptides of type I collagen increased more with teriparatide alone than with both (P < 0.001 for each marker).

Conclusion: Alendronate reduces the ability of teriparatide to increase BMD and bone turnover in women.

Figure 1

BMD of the posterior-anterior (PA) spine, femoral neck, one third radius, and total body determined by DXA in women randomized to alendronate alone (n = 29; red triangles), teriparatide alone (n = 20; blue squares), or both (n = 20; green circles). Teriparatide was begun at month 6. Data are plotted as the mean percent change (±sem). In women treated with teriparatide alone or teriparatide plus alendronate, data are presented starting at month 6 when teriparatide was begun. Error bars that are not seen are contained within the symbols.

Figure 2

Serum OC, P1NP, and N-telopeptide concentrations in women randomized to alendronate alone (n = 29; red triangles), teriparatide alone (n = 20; blue squares), or both (n = 20; green circles). Teriparatide was begun at month 6. Data are plotted as the mean percent change (±sem). Error bars that are not seen are contained within the symbols.