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Hetereogeneity in skeletal response to full-length parathyroid hormone in the treatment of osteoporosis

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Abstract

Summary

In the PaTH trial, among the 119 women randomized to parathyroid hormone PTH(1–84) and 60 to alendronate, we found much greater variation in BMD and markers in response to PTH(1–84) compared to alendronate. No baseline participant characteristic consistently predicted increased bone density response to PTH(1–84), although women with larger changes in 1,25 dihydroxyvitamin D during therapy had larger increases in BMD.

Introduction

We examined variability in BMD and markers of bone turnover in response to treatment with PTH(1–84) or alendronate in the PaTH trial.

Methods

Differences in SD were examined using Levine’s test for homogeneity of variance. Change in BMD across quartiles of participant characteristics was examined using ANOVA.

Results

We found much greater variation in response to PTH(1–84) compared to alendronate. The SD for change in cancellous spine BMD (by QCT) was 32% on PTH(1–84) compared to 13% on alendronate (p < 0.0001). The higher variability in the PTH(1–84) group was due to substantial numbers of women with large increases in BMD on PTH(1–84). Similarly, the SD of changes in markers of formation and resorption were significantly higher on PTH(1–84) than on ALN. No baseline participant characteristics predicted increased bone density response to PTH(1–84) therapy. However, change in 1,25-OH2D explained 16% of the variance in BMD response to PTH(1–84).

Conclusion

There is significant variability in the skeletal response to PTH(1–84), which exceeds that observed with alendronate. Changes in 1,25-OH2D were related to larger gains in BMD. This finding may have implications for elucidating either the pathway by which PTH affects the skeleton or traits that result in particular responsiveness to PTH therapy.

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Acknowledgements

This study was funded by NIAMS (NIAMS-045, N01-AR-9-2245). Study medications were provided by NPS Pharmaceuticals (parathyroid hormone and matching placebo) and Merck & Co., Inc. (alendronate and matching placebo).

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Authors and Affiliations

  1. Department of Medicine/Endocrinology, University of California San Francisco, San Francisco, CA, USA

    D. E. Sellmeyer

  2. Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA

    D. M. Black & L. Palermo

  3. University of Pittsburgh, Pittsburgh, PA, USA

    S. Greenspan

  4. Minneapolis VA Medical Center and University of Minnesota, Minneapolis, MN, USA

    K. Ensrud

  5. College of Physicians and Surgeons, Columbia University, New York, NY, USA

    J. Bilezikian

  6. Maine Center for Osteoporosis Research and Education, St. Joseph’s Hospital, Bangor, ME, USA

    C. J. Rosen

  7. 185 Berry Street, Lobby 4, Suite 5700, San Francisco, CA, 94107, USA

    D. E. Sellmeyer

Authors
  1. D. E. Sellmeyer
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  2. D. M. Black
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  3. L. Palermo
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  4. S. Greenspan
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  5. K. Ensrud
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  6. J. Bilezikian
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  7. C. J. Rosen
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Corresponding author

Correspondence to D. E. Sellmeyer.

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Sellmeyer, D.E., Black, D.M., Palermo, L. et al. Hetereogeneity in skeletal response to full-length parathyroid hormone in the treatment of osteoporosis. Osteoporos Int 18, 973–979 (2007). https://doi.org/10.1007/s00198-007-0336-x

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  • DOI: https://doi.org/10.1007/s00198-007-0336-x

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