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Cited by 493Bone health and osteoporosis researchBone health and treatmentsBone Metabolism and Diseases

Effects of teriparatide versus alendronate for treating glucocorticoid-induced osteoporosis: thirty-six-month results of a randomized, double-blind, controlled trial

Saag, Kenneth G., Zanchetta, Jose R., Devogelaer, Jean‐Pierre, Adler, Robert A., Eastell, Richard, See, Kyoungah, Krege, John H., Krohn, Kelly +1 more·2009·Arthritis & Rheumatism
DOI 10.1002/art.24879
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Abstract

OBJECTIVE: To compare the bone anabolic drug teriparatide (20 microg/day) with the antiresorptive drug alendronate (10 mg/day) for treating glucocorticoid-induced osteoporosis (OP). METHODS: This was a 36-month, randomized, double-blind, controlled trial in 428 subjects with OP (ages 22-89 years) who had received > or =5 mg/day of prednisone equivalent for > or =3 months preceding screening. Measures included changes in lumbar spine and hip bone mineral density (BMD), changes in bone biomarkers, fracture incidence, and safety. RESULTS: Increases in BMD from baseline were significantly greater in the teriparatide group than in the alendronate group, and at 36 months were 11.0% versus 5.3% for lumbar spine, 5.2% versus 2.7% for total hip, and 6.3% versus 3.4% for femoral neck (P < 0.001 for all). In the teriparatide group, median percent increases from baseline in N-terminal type I procollagen propeptide (PINP) and osteocalcin (OC) levels were significant from 1 to 36 months (P < 0.01), and increases in levels of C-terminal telopeptide of type I collagen (CTX) were significant from 1 to 6 months (P < 0.01). In the alendronate group, median percent decreases in PINP, OC, and CTX were significant by 6 months and remained below baseline through 36 months (P < 0.001). Fewer subjects had vertebral fractures in the teriparatide group than in the alendronate group (3 [1.7%] of 173 versus 13 [7.7%] of 169; P = 0.007), with most occurring during the first 18 months. There was no significant difference between groups in the incidence of nonvertebral fractures (16 [7.5%] of 214 subjects taking teriparatide versus 15 [7.0%] of 214 subjects taking alendronate; P = 0.843). More subjects in the teriparatide group (21%) versus the alendronate group (7%) had elevated predose serum calcium concentrations (P < 0.001). CONCLUSION: Our findings indicate that subjects with glucocorticoid-induced OP treated with teriparatide for 36 months had greater increases in BMD and fewer new vertebral fractures than subjects treated with alendronate.

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  • The anabolic agent hPTH (1-34) is superior to bisphosphonates in increasing spine and hip BMD and reduces the incidence of new vertebral fractures in glucocorticoid-induced osteoporosis populations for both men and women.

    “In support of this notion, it is reported that anabolic agent, hPTH (1-34), is superior to bisphosphonates in increasing spine and hip BMD and reduces the incidence of new vertebral fractures in glucocorticoid-induced osteoporosis (GIOP) populations for both men and women [11, 47-49].”

    From Prevention of glucocorticoid induced bone changes with beta-ecdysone (2015) · cites this paper as [49]

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Authors
Saag, K. G., Zanchetta, J. R., Devogelaer, J., Adler, R. A., Eastell, R., See, K., Krege, J. H., Krohn, K., & Warner, M. R.
Affiliations
  • University of Alabama at Birmingham (US)
  • UCLouvain (BE)
  • Hunter Holmes McGuire VA Medical Center (US)
  • University of Sheffield (GB)
  • Eli Lilly (United States) (US)
ORCID
Venue
Arthritis & Rheumatism
Publisher
Wiley
Published
2009-10-29
Volume
60
Issue
11
Pages
3346-3355
ISSN
  • 0004-3591 (ISSN-L)
  • 1529-0131
DOI
10.1002/art.24879
OpenAlex
W1992310701
Cited by
493
References
35
Citations by year
2026: 10 · 2025: 16 · 2024: 23 · 2023: 21 · 2022: 35 · 2021: 34 · 2020: 31 · 2019: 31 · 2018: 34 · 2017: 28 · 2016: 27 · 2015: 37 · 2014: 31 · 2013: 35 · 2012: 29
FWCI
34.48
Type
journal article
Language
en
Open access
closed
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Arthritis & Rheumatism (publishedVersion)
  • PubMed (publishedVersion)
  • DIAL (Catholic University of Leuven) (submittedVersion)
Funders
Eli Lilly and Company
Topics
  • Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
  • Health Sciences › Medicine › Oncology › Bone health and treatments
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Bone Metabolism and Diseases
Keywords
glucocorticoid-induced osteoporosis, teriparatide, alendronate, bone mineral density, bone turnover markers, P1NP, osteocalcin, CTX, vertebral fractures, non-vertebral fractures, fracture risk, antiresorptive therapy, bone anabolic therapy, drug safety, long-term treatment outcomes, femoral neck
MeSH terms
Adult, Aged, Dose-Response Relationship, Drug, Double-Blind Method, Female, Glucocorticoids, Hip Joint, Humans, Longitudinal Studies, Lumbar Vertebrae, Male, Middle Aged, Osteoporosis, Peptide Fragments, Peptides, Procollagen, Radiography, Rheumatic Diseases, Bone Density, Osteocalcin, Treatment Outcome, Teriparatide, Alendronate, Collagen Type I, Bone Density Conservation Agents

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