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Early Responsiveness of Women with Osteoporosis to Teriparatide After Therapy with Alendronate or Risedronate

Colorado Center for Bone Research (P.D.M.), Lakewood, Colorado 80227; Institut National de la Santé et de la Recherche Médicale Research Unit 831 (P.D.D.) and Claude Bernard University Lyon 1, 69372 Lyon, France; Regional Bone Center (R.L.), Helen Hayes Hospital, West Haverstraw, New York 10993; University of Cincinnati Bone Health and Osteoporosis Center (N.B.W.), Cincinnati, Ohio 45219; St. Barnabas Osteoporosis Center (M.L.), Livingston, New Jersey 07039; St. Joseph’s Healthcare (J.A.), McMaster University, Hamilton, Ontario, Canada L8S4L8; Division of Clinical Immunology and Rheumatology (K.S.), University of Alabama at Birmingham, Birmingham, Alabama 35233; University of Pittsburgh Medical Center (S.L.G.), Pittsburgh, Pennsylvania 15213; Endocrinology Department (E.S.), Austin Health, University of Melbourne, Victoria 3010, Australia; Bone Research Unit (S.B.), Leuven University, Department of Experimental Medicine, B-3000 Leuven, Belgium; sanofi-aventis (S.M.), Bridgewater, New Jersey 08807; Department of Radiology (T.F.L.), Center for Molecular and Functional Imaging, University of California at San Francisco, San Francisco, California 94107; and Division of Endocrinology (J.P.B.), Metabolic Bone Diseases Unit, Columbia University College of Physicians and Surgeons, New York, New York 10021

Address all correspondence and requests for reprints to: Paul D. Miller, M.D., Colorado Center for Bone Research, 3190 South Wadsworth Boulevard, Suite 250, Lakewood, Colorado 80227. E-mail: MillerCCBR{at}aol.com.

Background: Anabolic responsiveness to teriparatide can be blunted or delayed in patients previously treated with alendronate. The extent of this effect is different for other antiresorptives. This study evaluated the early anabolic effects of teriparatide in postmenopausal women with osteoporosis previously treated with alendronate or risedronate.

Methods: Patients treated for at least 24 months with alendronate or risedronate discontinued their bisphosphonate and received teriparatide for 12 months. The primary endpoint was a comparison of changes from baseline in N-terminal propeptide of type 1 collagen after 3 months between prior bisphosphonate groups. We also examined changes in other bone turnover markers, bone mineral density (BMD), and relationships between early changes in bone turnover markers and 12-month areal and volumetric BMD.

Results: In the prior risedronate group, the N-terminal propeptide of type 1 collagen increase was significantly greater after 3 months of teriparatide than in the prior alendronate group (mean ± SE, 86.0 ± 5.6 vs. 61.2 ± 5.3 ng/ml, respectively; P < 0.001). Findings were similar for the other bone turnover markers. The changes in areal BMD and trabecular spine volumetric BMD were also greater in the prior risedronate group (P < 0.05). Early changes in bone turnover markers correlated with changes in trabecular spine volumetric BMD at 12 months (Spearman r = 0.45). Teriparatide was well tolerated.

Conclusion: This nonrandomized but prospective study suggests that there may be differences in anabolic responsiveness to teriparatide as a function of the type of prior bisphosphonate exposure.

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