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Effects of teriparatide on serum calcium in postmenopausal women with osteoporosis previously treated with raloxifene or alendronate

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Abstract

Summary

The effect of teriparatide (20 μg/day) on serum calcium was examined in postmenopausal women previously treated with alendronate or raloxifene. Women previously treated with alendronate or raloxifene who added teriparatide or switched to teriparatide did not have clinically meaningful increases in mean predose serum calcium.

Introduction

The effects of a 6-month treatment with teriparatide (20 μg/day; rhPTH(1–34), TPTD) on serum calcium (Ca) was examined in a prospective study of postmenopausal women previously treated with alendronate (70 mg/week or 10 mg/day [ALN] or raloxifene 60 mg/d [RLX]) for ≥18 months.

Methods

Women continued their usual ALN or RLX during a 2-month antiresorptive phase. Women previously treated with ALN were randomized to add TPTD (n = 52) or switch to TPTD (n = 50) and women previously treated with RLX were randomized to add TPTD (n = 47) or switch to TPTD (n = 49). All were to take at least 500 mg/day of elemental Ca and 400–800 IU/day of vitamin D.

Results

Predose mean serum Ca did not significantly change in groups adding TPTD to either RLX or ALN treatment. In patients who switched from RLX or ALN to TPTD, mean serum Ca increased by 0.05 mmol/L and 0.04 mmol/L respectively. Only 1 patient had the predefined calcium endpoint of serum calcium > 2.76 mmol/L (11 mg/dL) at more than one visit.

Conclusions

Women previously treated with ALN or RLX who added TPTD or switched to TPTD did not have clinically meaningful increases in mean predose serum Ca.

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References

  1. Jiang Y, Zhao JJ, Mitlak BH et al (2003) Recombinant human parathyroid hormone (1–34) [teriparatide] improves both cortical and cancellous bone structure. J Bone Miner Res 18:1932–1941

    Article  PubMed  CAS  Google Scholar 

  2. Paschalis EP, Glass EV, Donley DW et al (2005) Bone mineral and collagen quality in iliac crest biopsies of patients given teriparatide: new results from the fracture prevention trial. J Clin Endocrinol Metab 90:4644–4649

    Article  PubMed  CAS  Google Scholar 

  3. Misof BM, Roschger P, Cosman F et al (2003) Effects of intermittent parathyroid hormone administration on bone mineralization density in iliac crest biopsies from patients with osteoporosis: a paired study before and after treatment. J Clin Endocrinol Metab 88:1150–1156

    Article  PubMed  CAS  Google Scholar 

  4. Ma YL, Zeng Q, Donley DW et al (2006) Teriparatide increases bone formation in modeling and remodeling osteons and enhances IGF-II immunoreactivity in postmenopausal women with osteoporosis. J Bone Miner Res 21:855–864

    Article  PubMed  CAS  Google Scholar 

  5. Lindsay R, Cosman F, Zhou H et al (2006) A novel tetracycline labeling schedule for longitudinal evaluation of the short-term effects of anabolic therapy with a single iliac crest bone biopsy: early actions of teriparatide. J Bone Miner Res 21:366–373

    Article  PubMed  CAS  Google Scholar 

  6. Keaveny TM, Donley DW, Hoffmann PF et al (2007) The 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 22(1):149–157

    Article  PubMed  CAS  Google Scholar 

  7. 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 344:1434–1441

    Article  PubMed  CAS  Google Scholar 

  8. Krege JH, Donley DW, Marcus R (2005) Teriparatide, osteoporosis, calcium, and vitamin D. N Engl J Med 353:634–635

    Article  PubMed  CAS  Google Scholar 

  9. Ettinger B, San Martin J, Crans G et al (2004) Differential effects of teriparatide on BMD after treatment with raloxifene or alendronate. J Bone Miner Res 19:745–751

    Article  PubMed  CAS  Google Scholar 

  10. Forteo United States Package Insert (2004) Eli Lilly and Company

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

    Article  PubMed  CAS  Google Scholar 

  12. Perez-Ruiz F, Calabozo M, Erauskin GG et al (2002) Renal underexcretion of uric acid is present in patients with apparent high urinary uric acid output. Arthritis Rheum 47:610–613

    Article  PubMed  CAS  Google Scholar 

  13. Wermers RA, Khosla S, Atkinson EJ et al (1998) Survival after the diagnosis of hyperparathyroidism: a population-based study. Am J Med 104:115–122

    Article  PubMed  CAS  Google Scholar 

  14. Antoniucci DM, Sellmeyer DE, Bilezikian JP et al (2007) Elevations in serum and urinary calcium with parathyroid hormone (1–84) with and without alendronate for osteoporosis. J Clin Endocrinol Metab 92:942–947

    Article  PubMed  CAS  Google Scholar 

  15. Greenspan SL, Bone HG, Ettinger MP et al (2007) Effect of recombinant human parathyroid hormone (1–84) on vertebral fracture and bone mineral density in postmenopausal women with osteoporosis: a randomized trial. Ann Intern Med 146:326–339

    PubMed  Google Scholar 

  16. Heath H III (2005) Postural and venous stasis-induced changes in total calcium. Mayo Clin Proc 80:1101

    Article  PubMed  Google Scholar 

  17. Wronski TJ, Yen CF, Qi H et al (1993) Parathyroid hormone is more effective than estrogen or bisphosphonates for restoration of lost bone mass in ovariectomized rats. Endocrinology 132:823–831

    Article  PubMed  CAS  Google Scholar 

  18. Hock JM (2001) Anabolic actions of PTH in the skeleton of animals. J Musculoskelet Neuronal Interact 2:33–47

    PubMed  CAS  Google Scholar 

  19. Schmidt IU, Dobnig H, Turner RT (1995) Intermittent parathyroid hormone treatment increases osteoblast number, steady state messenger ribonucleic acid levels for osteocalcin, and bone formation in tibial metaphysis of hypophysectomized female rats. Endocrinology 136:5127–5134

    Article  PubMed  CAS  Google Scholar 

  20. Onyia JE, Bidwell J, Herring J et al (1995) In vivo, human parathyroid hormone fragment (hPTH 1–34) transiently stimulates immediate early response gene expression, but not proliferation, in trabecular bone cells of young rats. Bone 17:479–484

    Article  PubMed  CAS  Google Scholar 

  21. 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  PubMed  CAS  Google Scholar 

  22. Shen V, Dempster DW, Birchman R et al (1993) Loss of cancellous bone mass and connectivity in ovariectomized rats can be restored by combined treatment with parathyroid hormone and estradiol. J Clin Invest 91:2479–2487

    Article  PubMed  CAS  Google Scholar 

  23. Whitfield JF, Morley P, Willick GE et al (1999) Stimulation of femoral trabecular bone growth in ovariectomized rats by human parathyroid hormone (hPTH)-(1–30)NH(2). Calcif Tissue Int 65:143–147

    Article  PubMed  CAS  Google Scholar 

  24. Heath D (1996) Familial hypocalcemia—not hypoparathyroidism. N Engl J Med 335:1144–1145

    Article  PubMed  CAS  Google Scholar 

  25. Dempster DW, Parisien M, Silverberg SJ et al (1999) On the mechanism of cancellous bone preservation in postmenopausal women with mild primary hyperparathyroidism. J Clin Endocrinol Metab 84:1562–1566

    Article  PubMed  CAS  Google Scholar 

  26. Sato M, Miyauchi A, Takahara J (2000) Clinical aspects of hyperparathyroidism in Japanese multiple endocrine neoplasia type 1. Biomed Pharmacother 54 [Suppl 1]:86s–89s

    Article  PubMed  CAS  Google Scholar 

  27. Dobnig H, Turner RT (1997) The effects of programmed administration of human parathyroid hormone fragment (1–34) on bone histomorphometry and serum chemistry in rats. Endocrinology 138:4607–4612

    Article  PubMed  CAS  Google Scholar 

  28. Deal C, Omizo M, Schwartz EN et al (2005) Combination teriparatide and raloxifene therapy for postmenopausal osteoporosis: results from a 6-month double-blind placebo-controlled trial. J Bone Miner Res 20:1905–1911

    Article  PubMed  CAS  Google Scholar 

  29. Licata AA (2005) Osteoporosis, teriparatide, and dosing of calcium and vitamin D. N Engl J Med 352:1930–1931

    Article  PubMed  CAS  Google Scholar 

  30. Wermers RA, Khosla S, Atkinson EJ et al (2006) Incidence of primary hyperparathyroidism in Rochester, Minnesota, 1993–2001: An update on the changing epidemiology of the disease. J Bone Miner Res 21:171–177

    Article  PubMed  Google Scholar 

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Acknowledgements

We wish to thank Erik Eriksen, Sundeep Khosla, Robert Marcus, and Hunter Heath for their contributions to the design and initiation of the study. We thank David Donley for co-authoring the protocol, Rachel Wagman for assistance with implementing the study and Melinda Rance for assistance in the preparation of the figures.

Funding

Funding was provided by Lilly Research Laboratories, Indianapolis, Indiana, USA.

Conflicts of interest

Robert Wermers has received grant support from Eli Lilly and Company. Felicia Cosman has received consulting fees from Eli Lilly and Company. Li Xie, Emmett Glass, and John Krege are all employees of Eli Lilly and Company.

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Authors and Affiliations

  1. Division of Endocrinology and Metabolism, Mayo Clinic, Rochester, MN, USA

    R. A. Wermers

  2. United Osteoporosis Centers, Gainesville, GA, USA

    C. P. Recknor

  3. Clinical Research Center, Helen Hayes Hospital, West Haverstraw, NY, USA

    F. Cosman

  4. Eli Lilly and Company, Lilly Corporate Center, Drop Code 6134, Indianapolis, IN, 46285, USA

    L. Xie, E. V. Glass & J. H. Krege

Authors
  1. R. A. Wermers
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  2. C. P. Recknor
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  3. F. Cosman
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  4. L. Xie
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  5. E. V. Glass
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  6. J. H. Krege
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Corresponding author

Correspondence to J. H. Krege.

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Wermers, R.A., Recknor, C.P., Cosman, F. et al. Effects of teriparatide on serum calcium in postmenopausal women with osteoporosis previously treated with raloxifene or alendronate. Osteoporos Int 19, 1055–1065 (2008). https://doi.org/10.1007/s00198-007-0557-z

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  • DOI: https://doi.org/10.1007/s00198-007-0557-z

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