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Teriparatide had positive outcomes on BMD in postmenopausal women
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Teriparatide therapy improved bone mineral density and increased bone formation markers in postmenopausal women with osteoporosis even after previous long-term antiresorptive treatment, according to a recent study.
Researchers conducted a secondary analysis of the effects of 20 mg of teriparatide (Forteo, Eli Lilly) daily and 500 mg of elemental calcium and 400 IU to 800 IU of vitamin D for two years. They randomly assigned 245 women into one of four treatment arms: an alendronate group (n=107), a risedronate group (n=59), an etidronate group (n=30) or a nonbisphosphonate group (n=49).
Findings showed increases in bone formation markers in all groups after one month of teriparatide treatment. There was a decrease in hip BMD in all groups that subsequently reversed, and lumbar spine increased at all visits. The etidronate group had BMD increases at the spine but not at the hip. BMD at skeletal sites was not affected by the duration of antiresorptive therapy. – by Christen Haigh
J Clin Endocrinol Metab. 2008; doi:10.1210/jc.2007-0711.
Clinical experience in the United States has been mixed. I have spoken with many physicians who see no problem whatsoever in treating patients who had extensive bisphosphonate exposure. Other physicians have seen disappointing BMD responses. It is hard to predict or to find factors that would predict just who will have a brisk response. It does appear that individuals whose remodeling activity is severely suppressed on bisphosphonates may have less response to teriparatide than those whose remodeling has not been severely suppressed. What is missing in all of this discussion, however, is any information regarding the effect of bisphosphonates on the teriparatide-associated reduction in fracture incidence. That would take a huge study that nobody is about to undertake at present, so the discussion has to center primarily around the surrogate endpoints of markers and BMD.
– Robert Marcus, MD
Senior Medical Fellow, Eli Lilly & Company