Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Article
  • Published:
Osteoporosis International Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

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

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

  5. 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 102:274–282

    Article  CAS  PubMed  Google Scholar 

  6. 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 87:4033–4041

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  8. 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 44:1496–1503

    Article  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  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 163:2619–2624

    Article  PubMed  Google Scholar 

  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 63:324–325

    Article  CAS  PubMed  Google Scholar 

  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 23:105–109

    Article  PubMed  Google Scholar 

  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 17:8–19

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  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 136:3632–3638

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  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 11:984–996

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  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 44:202–211

    Article  CAS  PubMed  Google Scholar 

  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 42:2309–2318

    Article  CAS  PubMed  Google Scholar 

  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 15:1006–1013

    Article  CAS  PubMed  Google Scholar 

  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):801–807

    Article  CAS  PubMed  Google Scholar 

  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 67:277–285

    Article  CAS  PubMed  Google Scholar 

  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 17:716–723

    Article  CAS  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  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 102:1627–1633

    Article  CAS  PubMed  Google Scholar 

  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 14:77–81

    Article  CAS  PubMed  Google Scholar 

  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 22:1173–1180

    Article  CAS  PubMed  Google Scholar 

  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 112:281–289

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  Google Scholar 

  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 21:149–157

    Article  Google Scholar 

  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 42:882–890

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  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):1434–1441

    Article  CAS  PubMed  Google Scholar 

  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 18:9–17

    Article  CAS  PubMed  Google Scholar 

  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 333:1437–1443

    Article  CAS  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This study was supported by Eli Lilly and Company. The authors acknowledge the study investigators [20] and also acknowledge JoNita Cogburn, Ph.D., i3 Statprobe for editorial assistance.

Conflicts of interest

BL Langdahl is a lecturer for Eli Lilly and Company, Novartis, Amgen, Servier, Roche, and Merck Sharp & Dohme and serves on advisory boards for Eli Lilly and Company, Novartis, and Amgen.

E Shane receives research support from Novartis and Eli Lilly and Company.

H Dobnig is a lecturer at symposia organized by Eli Lilly and Company.

JR Zanchetta has received consultant fees and/or research grants from Sanofi-Aventis, GlaxoSmithKline, MSD, Eli Lilly and Company, Wyeth, Amgen, Pfizer, Roche, and Servier.

M Maricic is a lecturer for and has received research grant support from Eli Lilly and Company.

F Marin, K Krohn, K See, and MR Warner are employees and stockholders of Eli Lilly and Company.

Author information

Authors and Affiliations

  1. Åarhus University Hospital, Åarhus Sygehus, Tage Hansens Gade 2, 8000, Åarhus, Denmark

    B. L. Langdahl

  2. Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA

    F. Marin, K. Krohn, K. See & M. R. Warner

  3. Columbia University, New York, NY, USA

    E. Shane

  4. Medical University of Graz, Graz, Austria

    H. Dobnig

  5. Instituto de Investigaciones Metabólicas, School of Medicine, USAL University, Buenos Aires, Argentina

    J. R. Zanchetta

  6. Catalina Pointe Arthritis and Rheumatology Specialists, Tucson, AZ, USA

    M. Maricic

Authors
  1. B. L. Langdahl
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. F. Marin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. E. Shane
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. H. Dobnig
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. J. R. Zanchetta
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. M. Maricic
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. K. Krohn
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. K. See
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. M. R. Warner
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to B. L. Langdahl.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Langdahl, B.L., Marin, F., Shane, E. et al. Teriparatide versus alendronate for treating glucocorticoid-induced osteoporosis: an analysis by gender and menopausal status. Osteoporos Int 20, 2095–2104 (2009). https://doi.org/10.1007/s00198-009-0917-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-009-0917-y

Keywords

Search

Navigation