Teriparatide Reduces Bone Microdamage Accumulation in Postmenopausal Women Previously Treated With Alendronate |
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| Authors: | Harald Dobnig Jan J Stepan David B Burr Jiliang Li Dana Michalská Adrien Sipos Helmut Petto Astrid Fahrleitner‐Pammer Imre Pavo |
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| Affiliation: | 1. Department of Internal Medicine, Division of Endocrinology and Nuclear Medicine, Medical University of Graz, Graz, Austria;2. Institute of Rheumatology, Charles University, Faculty of Medicine, Prague, Czech Republic;3. Department of Anatomy and Cell Biology and Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA;4. Dr. Burr is a member of the Scientific Advisory Board for Eli Lilly and Co. He also serves as a consultant to The Alliance for Better Bone Health. He has research support from Eli Lilly and Co., The Alliance for Better Bone Health, and Amgen. Drs. Sipos and Pavo are shareholders and fulltime employees of Eli Lilly and Co. Dr. Petto is a full‐time employee of Eli Lilly and Co. All other authors state that they have no conflicts of interests.;5. Department of Biology, Indiana University‐Purdue University, Indianapolis, Indiana, USA;6. Department of Internal Medicine 3, Charles University, Faculty of Medicine, Prague, Czech Republic;7. Lilly Research Laboratories, Indianapolis, Indiana, USA |
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| Abstract: | Suppression of bone turnover by bisphosphonates is associated with increased bone microdamage accumulation in animal models. Our objective was to study the effects of teriparatide treatment on changes in microdamage accumulation at the iliac crest in previously treatment‐naïve patients or in those switched from alendronate to teriparatide. Sixty‐six postmenopausal women with osteoporosis (mean age, 68.0 yr; and mean BMD T‐score of ?2.8 at lumbar spine and ?1.7 at total hip; 62% with prevalent fractures) entered this prospective, nonrandomized study and started with 24‐mo 20 μg/d subcutaneous teriparatide treatment in monotherapy: 38 patients stopped previous alendronate treatment (10 mg/d or 70 mg/wk for a mean duration of 63.6 mo) and switched to teriparatide, whereas 28 were previously treatment naïve. Thirty‐one paired biopsies with two intact cortices were collected and analyzed for microstructure and microdamage accumulation at baseline and after 24 mo of teriparatide administration. After 24 mo of teriparatide treatment, crack density (Cr.Dn), crack surface density (Cr.S.Dn), and crack length (Cr.Le) were decreased in previously alendronate‐treated patients, whereas only Cr.Le was reduced in former treatment‐naïve patients. Patients with lower initial femoral neck BMD also showed a higher reduction of microdamage accumulation. Better bone microarchitecture correlated positively, whereas bone turnover markers and age did not correlate with reduced microdamage accumulation on teriparatide. In conclusion, teriparatide reduces microdamage accumulation in the iliac crest of patients previously treated with alendronate. There is insufficient evidence to suggest that age or bone turnover would be associated with this change. |
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| Keywords: | osteoporosis histomorphometry bone microdamage alendronate teriparatide |
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