Comparative Effects of Teriparatide and Strontium Ranelate on Bone Biopsies and Biochemical Markers of Bone Turnover in Postmenopausal Women With Osteoporosis |
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Authors: | Robert R Recker Fernando Marin Sophia Ish‐Shalom Rüdiger Möricke Federico Hawkins Georgios Kapetanos María P de la Peña Jörn Kekow Jordi Farrerons Beatriz Sanz Heide Oertel Jan Stepan |
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Affiliation: | 1. Osteoporosis Research Center, Creighton University, Omaha, Nebraska, USA;2. Lilly Research Centre, Windlesham, United Kingdom;3. Bone and Mineral Metabolism Unit, Rambam Health Care Campus, Technion Faculty of Medicine, Haifa, Israel;4. Endocrinology Clinical Research Laboratory, Magdeburg, Germany;5. Endocrinology, Hospital 12 de Octubre, Madrid, Spain;6. Orthopedic Surgery, Aristotelion University, Thessaloniki, Greece;7. Clínica Médica Monraz, Guadalajara, Mexico;8. Rheumatology, Speciality Hospital, Vogelsang‐Gommern, Germany;9. Internal Medicine, Hospital Santa Creu i Sant Pau, Barcelona, Spain;10. Faculty of Medicine, Charles University, Prague, Czech Republic |
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Abstract: | We assessed the effects on bone remodeling and histomorphometry after daily subcutaneous injections of teriparatide (n = 39, 20 μg/d) or oral strontium ranelate (SrR, n = 40, 2 g/d) in postmenopausal women with osteoporosis. Evaluable biopsies were obtained from 29 patients in the teriparatide group and 22 in the SrR group after 6 mo of treatment. The mean ± SD mineralization surfaces as a percent of bone surfaces (MS/BS, %) at the trabecular level were 7.73 ± 1.48% for teriparatide and 5.25 ± 1.15% for SrR (p = 0.219) and at the endocortical level were 17.22 ± 3.06% and 9.70 ± 2.07%, respectively (p = 0.052). Cortical porosity was 5.40 ± 0.41% in the teriparatide and 4.14 ± 0.40% in the SrR group (p = 0.037). Teriparatide induced significant increases from baseline in bone formation and resorption markers, reaching statistical significance for amino‐terminal propeptide of type I collagen (PINP) after 1 mo (+57%, p < 0.001). SrR induced small, but statistically significant, reductions from baseline in PINP at 3 (?14%, p = 0.005) and 6 mo (?19%, p < 0.001) and in serum β‐C‐terminal telopeptide of type I collagen (β‐CTX) at 1 and 3 mo (?11%, for both, p < 0.05). There were more patients with adverse events after SrR (70%) than teriparatide (41%) treatment (p = 0.013). In conclusion, the changes in biochemical markers of bone formation confirmed bone‐forming activity of teriparatide but not of SrR treatment. The effects of SrR on bone remodeling and cell activity were modest, indicating that its effects on fracture reduction may be predominantly mediated through a different mechanism than that observed with anabolic or more potent antiresorptive agents. |
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Keywords: | bone marker bone biopsy osteoporosis strontium teriparatide |
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