Teriparatide demonstrated greater increases in BMD, fewer vertebral fractures than alendronate

Teriparatide treatment led to a greater increase in bone mineral density and fewer vertebral fractures compared with alendronate treatment in patients with glucocorticoid-induced osteoporosis, according to recently published data.

Researchers conducted a 36-month, randomized, double-blind, controlled trial at 76 centers in 13 countries, and enrolled 428 patients aged 22 to 89 years who had confirmed osteoporosis. All patients had received 5 mg or more of prednisone per day for three months or longer. The researchers randomly assigned 150 patients to 20 mcg per day teriparatide plus oral placebo and 144 patients to 10 mg per day oral alendronate plus injectable placebo. Participants also received calcium and vitamin D supplements.

At 36 months, BMD for the lumbar spine was 11% higher than baseline in the teriparatide group and 5.3% higher than baseline in the alendronate group. For total hip, BMD increased by 5.2% for the teriparatide group and by 2.7% for the alendronate group; for femoral neck, BMD increased by 6.3% with teriparatide and by 3.4% with alendronate (P<.001 for all). New vertebral fractures occurred in 1.7% of patients assigned teriparatide and in 7.7% of patients assigned alendronate (P=.007). However, the incidence of nonvertebral fractures did not differ between the two groups. Patients in the teriparatide group sustained increases in markers of bone formation for 36 months, while patients in the alendronate group sustained decreases in biomarkers of bone formation and resorption.

The researchers noted higher levels of predose calcium concentration in the teriparatide group: 21% vs. 7% in the alendronate group.

Saag KG. Arthritis Rheum. 2009;60:3346-3355.