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01.12.2009 | Original Article

Teriparatide versus alendronate for treating glucocorticoid-induced osteoporosis: an analysis by gender and menopausal status

verfasst von: B. L. Langdahl, F. Marin, E. Shane, H. Dobnig, J. R. Zanchetta, M. Maricic, K. Krohn, K. See, M. R. Warner

Erschienen in: Osteoporosis International | Ausgabe 12/2009

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Abstract

Summary

The effects of teriparatide versus alendronate were compared by gender and menopausal status in patients with glucocorticoid-induced osteoporosis. At 18 months, increases in lumbar spine BMD were significantly greater in the teriparatide versus alendronate group in postmenopausal women (7.8% versus 3.7%, p < 0.001), premenopausal women (7.0% versus 0.7%, p < 0.001), and men (7.3% versus 3.7%, p = 0.03).

Introduction

In patients with glucocorticoid-induced osteoporosis (GIO), teriparatide significantly increased bone mineral density (BMD) and decreased vertebral fractures compared with alendronate. We examined effects of teriparatide versus alendronate by gender and menopausal status.

Methods

This was a multicenter, randomized, double-blind study of teriparatide 20 µg/day versus alendronate 10 mg/day in patients with GIO (277 postmenopausal women, 67 premenopausal women, 83 men). Primary outcome was change in lumbar spine BMD. Secondary outcomes included change in hip BMD, change in bone biomarkers, fracture incidence, and safety.

Results

At 18 months, mean percent increases from baseline in lumbar spine BMD were significantly greater in the teriparatide versus alendronate group in postmenopausal women (7.8% versus 3.7%, p < 0.001), premenopausal women (7.0% versus 0.7%, p < 0.001), and men (7.3% versus 3.7%, p = 0.03). Radiographic vertebral fractures occurred in one teriparatide (one postmenopausal) and ten alendronate patients (six postmenopausal, four men), and nonvertebral fractures occurred in 12 teriparatide (nine postmenopausal, two premenopausal, one man) and eight alendronate patients (six postmenopausal, two men). The proportion of patients reporting adverse events in teriparatide versus alendronate groups was consistent across subgroups.

Conclusion

Among men and pre- and postmenopausal women with GIO, lumbar spine BMD increased more in patients receiving teriparatide compared with alendronate.

Van Staa TP, Leufkens HGM, Abenhaim L et al (2000) Use of oral corticosteroids and risk for fractures. J Bone Miner Res 15:993–1000CrossRefPubMed

Saag KG (2003) Glucocorticoid-induced osteoporosis. Endocrinol Metab Clin North Am 32:135–157CrossRefPubMed

Canalis E, Mazziotti G, Giustina A et al (2004) Glucocorticoid-induced osteoporosis: pathophysiology and perspective. Osteoporos Int 18:1319–1328CrossRef

Kanis JA, Johansson H, Oden A et al (2004) A meta-analysis of prior corticosteroid use and fracture risk. J Bone Miner Res 19:893–899CrossRefPubMed

Weinstein RS, Jilka RL, Parfitt AM et al (1998) Inhibition of osteoblastogenesis and promotion of apoptosis of osteoblasts and osteocytes by glucocorticoids. Potential mechanisms of their deleterious effects on bone. J Clin Invest 102:274–282CrossRefPubMed

Rubin MR, Bilezikian JP (2002) The role of parathyroid hormone in the pathogenesis of glucocorticoid-induced osteoporosis: a reexamination of the evidence. J Clin Endocrinol Metab 87:4033–4041CrossRefPubMed

Schakman O, Gilson H, Thissen JP (2008) Mechanism of glucocorticoid-induced myopathy. J Endocrinol 197:1–10CrossRefPubMed

American College of Rheumatology (2001) Recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis: 2001 update. American College of Rheumatology Ad Hoc Committee on Glucocorticoid-Induced Osteoporosis. Arthritis Rheum 44:1496–1503CrossRef

Sambrook PN, Diamond T, Ferris L et al (2001) Corticosteroid induced osteoporosis. Guidelines for treatment. Aust Fam Physician 30:793–796PubMed

10.

Royal College of Physicians (2002) Glucocorticoid-induced osteoporosis: guidelines for prevention and treatment. London, UK. http://www.rcplondon.ac.uk/pubs/books/glucocorticoid/index.asp

11.

Adler RA, Hochberg MC (2003) Suggested guidelines for evaluation and treatment of glucocorticoid-induced osteoporosis for the Department of Veterans Affairs. Arch Intern Med 163:2619–2624CrossRefPubMed

12.

Geusens PP, de Nijs RN, Lems WF et al (2004) Prevention of glucocorticoid osteoporosis: a consensus document of the Dutch Society for Rheumatology. Ann Rheum Dis 63:324–325CrossRefPubMed

13.

Nawata H, Soen S, Takayanagi R et al (2005) Guidelines on the management and treatment of glucocorticoid-induced osteoporosis of the Japanese Society for Bone and Mineral Research. J Bone Miner Metab 23:105–109CrossRefPubMed

14.

Devogelaer JP, Goemaere S, Boonen S et al (2006) Evidence-based guidelines for the prevention and treatment of glucocorticoid-induced osteoporosis: a consensus document of the Belgian Bone Club. Osteoporos Int 17:8–19CrossRefPubMed

15.

Rogers MJ, Frith JC, Luckman SP et al (1999) Molecular mechanisms of action of bisphosphonates. Bone 24:73S–79SCrossRefPubMed

16.

Dobnig H, Turner RT (1995) Evidence that intermittent treatment with parathyroid hormone increases bone formation in adult rats by activation of bone lining cells. Endocrinology 136:3632–3638CrossRefPubMed

17.

Jilka RL, Weinstein RS, Bellido T et al (1999) Increased bone formation by prevention of osteoblast apoptosis with parathyroid hormone. J Clin Invest 104:439–446CrossRefPubMed

18.

Canalis E, Giustina A, Bilezikian JP (2007) Mechanisms of anabolic therapies for osteoporosis. N Engl J Med 357:905–916CrossRefPubMed

19.

Goltzman D (2008) Studies on the mechanisms of the skeletal anabolic action of endogenous and exogenous parathyroid hormone. Arch Biochem Biophys 473:218–224CrossRefPubMed

20.

Saag KG, Shane ES, Boonen S et al (2007) Teriparatide or alendronate in glucocorticoid-induced osteoporosis. New Eng J Med 357:2028–2039CrossRefPubMed

21.

Genant HK, Jergas M, Palermo L et al (1996) Comparison of semiquantitative visual and quantitative morphometric assessment of prevalent and incident vertebral fractures in osteoporosis. J Bone Miner Res 11:984–996CrossRefPubMed

22.

Saag KG, Emkey R, Schnitzer TJ et al (1998) Alendronate for the prevention and treatment of glucocorticoid-induced osteoporosis. N Engl J Med 339:292–299CrossRefPubMed

23.

Adachi JD, Saag KG, Delmas PD et al (2001) Two year effects of alendronate on bone mineral density and vertebral fracture in patients receiving glucocorticoids: a randomized, double blind, placebo controlled extension trial. Arthritis Rheum 44:202–211CrossRefPubMed

24.

Cohen S, Levy RM, Keller M et al (1999) Risedronate therapy prevents corticosteroid-induced bone loss: a twelve-month, multicenter, randomized, double-blind, placebo-controlled, parallel-group study. Arthritis Rheum 42:2309–2318CrossRefPubMed

25.

Reid DM, Hughes RA, Laan RF et al (2000) Efficacy and safety of daily risedronate in the treatment of corticosteroid-induced osteoporosis in men and women: a randomized trial. J Bone Miner Res 15:1006–1013CrossRefPubMed

26.

Ringe JD, Dorst A, Faber H et al (2003) Intermittent intravenous ibandronate injections reduce vertebral fracture risk in corticosteroid-induced osteoporosis: results from a long-term comparative study. Osteoporos Int 14(10):801–807CrossRefPubMed

27.

Wallach S, Cohen S, Reid DM et al (2000) Effects of risedronate treatment on bone density and vertebral fracture in patients on corticoid therapy. Calcif Tissue Int 67:277–285CrossRefPubMed

28.

Lems WF, Lodder MC, Lips P et al (2006) Positive effects of alendronate on bone mineral density and markers of bone turnover in patients with rheumatoid arthritis on chronic treatment with low-dose prednisone: a randomized, double-blind, placebo-controlled trial. Osteoporos Int 17:716–723CrossRefPubMed

29.

de Nijs RN, Jacobs JW, Lems WF et al (2006) Alendronate or alfacalcidol in glucocorticoid-induced osteoporosis. N Engl J Med 355:675–684CrossRefPubMed

30.

Sambrook PN (2007) Anabolic therapy in glucocorticoid-induced osteoporosis. N Engl J Med 357:2084–2086CrossRefPubMed

31.

Lane NE, Sanchez S, Modin GW et al (1998) Parathyroid hormone treatment can reverse corticosteroid-induced osteoporosis. Results of a randomized controlled clinical trial. J Clin Invest 102:1627–1633CrossRefPubMed

32.

Rehman Q, Lang TF, Arnaud CD et al (2003) Daily treatment with parathyroid hormone is associated with an increase in vertebral cross-sectional area in postmenopausal women with glucocorticoid-induced osteoporosis. Osteoporos Int 14:77–81CrossRefPubMed

33.

Chen P, Miller PD, Recker R et al (2007) Increases in BMD correlate with improvements in bone microarchitecture with teriparatide treatment in postmenopausal women with osteoporosis. J Bone Miner Res 22:1173–1180CrossRefPubMed

34.

Cummings SR, Karpf DB, Harris F et al (2002) Improvement in spine bone density and reduction in risk of vertebral fractures during treatment with antiresorptive drugs. Am J Med 112:281–289CrossRefPubMed

35.

Li Z, Meredith MP, Hoseyni MS (2001) A method to assess the proportion of treatment effect explained by a surrogate endpoint. Statist Med 20:3175–3188CrossRef

36.

Keaveny TM, Donley DW, Hoffmann PF, Mitlak BH, Glass EV, San Martin JA (2007) Effects of teriparatide and alendronate on vertebral strength as assessed by finite element modeling of QCT scans in women with osteoporosis. J Bone Miner Res 21:149–157CrossRef

37.

Ramsey-Goldman R, Dunn JE, Huang CF et al (1999) Frequency of fractures in women with systemic lupus erythematosus: comparison with United States population data. Arthritis Rheum 42:882–890CrossRefPubMed

38.

Steinbuch M, Youket TE, Cohen S (2004) Oral glucocorticoid use is associated with an increased risk of fracture. Osteoporos Int 15:323–328CrossRefPubMed

39.

Klaus J, Armbrecht G, Steinkamp M et al (2002) High prevalence of osteoporotic vertebral fractures in patients with Crohn's disease. Gut 51:654–658CrossRefPubMed

40.

Neer RM, Arnaud CD, Zanchetta JR et al (2001) Effect of parathyroid hormone(1–34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med 344(19):1434–1441CrossRefPubMed

41.

Orwoll ES, Scheele WH, Paul S et al (2003) The effect of teriparatide [human parathyroid hormone (1–34)] therapy on bone density in men with osteoporosis. J Bone Miner Res 18:9–17CrossRefPubMed

42.

Liberman UA, Weiss SR, Bröll J et al (1995) Effect of oral alendronate on bone mineral density and the incidence of fractures in postmenopausal osteoporosis. N Engl J Med 333:1437–1443CrossRefPubMed

43.

McDonough AK, Curtis JR, Saag KG (2008) The epidemiology of glucocorticoid-associated adverse events. Curr Opin Rheumatol 20:131–137CrossRefPubMed

Titel: Teriparatide versus alendronate for treating glucocorticoid-induced osteoporosis: an analysis by gender and menopausal status
verfasst von: B. L. Langdahl
F. Marin
E. Shane
H. Dobnig
J. R. Zanchetta
M. Maricic
K. Krohn
K. See
M. R. Warner
Publikationsdatum: 01.12.2009
Verlag: Springer-Verlag
Erschienen in: Osteoporosis International / Ausgabe 12/2009
Print ISSN: 0937-941X
Elektronische ISSN: 1433-2965
DOI: https://doi.org/10.1007/s00198-009-0917-y

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Teriparatide versus alendronate for treating glucocorticoid-induced osteoporosis: an analysis by gender and menopausal status

Abstract

Summary

Introduction

Methods

Results

Conclusion

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