This Article Full Text Full Text (PDF) Submit a related Letter to the Editor Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Copyright Permission Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Rittmaster, R. S. Articles by Rosen, C. J. Search for Related Content PubMed PubMed Citation Articles by Rittmaster, R. S. Articles by Rosen, C. J. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Medline Plus Health Information Osteoporosis Hazardous Substances DB PARATHYROID HORMONE

Enhancement of Bone Mass in Osteoporotic Women with Parathyroid Hormone followed by Alendronate¹

Department of Medicine and the Queen Elizabeth II Health Sciences Center, Dalhousie University (R.S.R.), Halifax, Nova Scotia B3H 2V9; Bethesda Health Research (M.B.), Bethesda, Maryland 20817; Clinical Research Center of South Florida (M.P.E.), Stuart, Florida 34996; Department of Medicine, University of Calgary (D.A.H.), Calgary, Alberta, Canada T2N 4N1; Department of Medicine and the St. Joseph’s Health Center, University of Western Ontario (A.B.H.), London, Ontario, Canada N6A 4V2; Department of Medicine, University of British Columbia (D.L.K.), Vancouver, British Columbia, Canada V5Z 3N9; and Department of Medicine, St. Joseph Hospital (C.J.R.), Bangor, Maine 04401

Address all correspondence and requests for reprints to: Roger S. Rittmaster, M.D., Glaxo Wellcome, Inc., 5 Moore Drive, Research Triangle Park, North Carolina 27709. E-mail: rsr89794{at}glaxowellcome.com

Treatment of osteoporosis with PTH causes a marked increase in vertebral bone mineral density (BMD). However, this effect is rapidly reversed when the treatment is stopped. The purpose of the present study was to determine whether the bisphosphonate alendronate could preserve or enhance bone density in patients previously treated with PTH. Sixty-six postmenopausal osteoporotic women were treated for 1 yr with 50, 75, or 100 µg recombinant human PTH-(1–84) or placebo, and then were given 10 mg alendronate daily for an additional year. BMD was measured in the femoral neck, lumbar spine, and whole body. Markers of bone turnover included skeletal alkaline phosphatase, osteocalcin, and N-telopeptide.

During the first year, changes in BMD (mean ± SD) in women receiving PTH (all doses combined) were 7.1 ± 5.6% (spine), 0.3 ± 6.2% (femoral neck), and -2.3 ± 3.3% (total body). After switching to alendronate for 1 yr in women who previously had received PTH, mean changes in BMD were 13.4 ± 6.4% (spine), 4.4 ± 7.2% (femoral neck), and 2.6 ± 3.1% (whole body). In the subgroup of patients who had received the highest dose of PTH, the mean increase in vertebral BMD was 14.6 ± 7.9%. All markers of bone turnover increased during treatment with PTH and decreased to below baseline after 1 yr of alendronate.

In conclusion, sequential treatment of osteoporosis with PTH and alendronate results in an increase in vertebral bone density that is considerably more than has been reported with alendronate or estrogens alone. This combination of drugs may be a useful approach to maximizing bone density in women with vertebral osteoporosis.

This article has been cited by other articles:

				A.E. Kearns and D.F. Kallmes Osteoporosis Primer for the Vertebroplasty Practitioner: Expanding the Focus Beyond Needles and Cement AJNR Am. J. Neuroradiol., November 1, 2008; 29(10): 1816 - 1822. [Abstract] [Full Text] [PDF]

				H. R. Johansson, R. Skripitz, and P. Aspenberg Bisphosphonates can block the deterioration in implant fixation after withdrawal of intermittent doses of parathyroid hormone J Bone Joint Surg Br, March 1, 2008; 90-B(3): 400 - 404. [Abstract] [Full Text] [PDF]

				A. Cranney, A. Papaioannou, N. Zytaruk, D. Hanley, J. Adachi, D. Goltzman, T. Murray, A. Hodsman, and for the Clinical Guidelines Committee of Osteoporo Parathyroid hormone for the treatment of osteoporosis: a systematic review. Can. Med. Assoc. J., July 4, 2006; 175(1): 52 - 59. [Abstract] [Full Text] [PDF]

				H. Liu, K. Michaud, S. Nayak, D. B. Karpf, D. K. Owens, and A. M. Garber The Cost-effectiveness of Therapy With Teriparatide and Alendronate in Women With Severe Osteoporosis. Arch Intern Med, June 12, 2006; 166(11): 1209 - 1217. [Abstract] [Full Text] [PDF]

				D. C. Bauer, P. Garnero, J. P. Bilezikian, S. L. Greenspan, K. E. Ensrud, C. J. Rosen, L. Palermo, D. M. Black, and for the PTH and Alendronate (PaTH) Research Group Short-Term Changes in Bone Turnover Markers and Bone Mineral Density Response to Parathyroid Hormone in Postmenopausal Women with Osteoporosis J. Clin. Endocrinol. Metab., April 1, 2006; 91(4): 1370 - 1375. [Abstract] [Full Text] [PDF]

				B. T. Summey and G. Yosipovitch Glucocorticoid-Induced Bone Loss in Dermatologic Patients: An Update Arch Dermatol, January 1, 2006; 142(1): 82 - 90. [Abstract] [Full Text] [PDF]

				D. M. Black, J. P. Bilezikian, K. E. Ensrud, S. L. Greenspan, L. Palermo, T. Hue, T. F. Lang, J. A. McGowan, C. J. Rosen, and the PaTH Study Investigators One Year of Alendronate after One Year of Parathyroid Hormone (1-84) for Osteoporosis N. Engl. J. Med., August 11, 2005; 353(6): 555 - 565. [Abstract] [Full Text] [PDF]

				C. J. Rosen Postmenopausal Osteoporosis N. Engl. J. Med., August 11, 2005; 353(6): 595 - 603. [Full Text] [PDF]

				A. B. Hodsman, D. C. Bauer, D. W. Dempster, L. Dian, D. A. Hanley, S. T. Harris, D. L. Kendler, M. R. McClung, P. D. Miller, W. P. Olszynski, et al. Parathyroid Hormone and Teriparatide for the Treatment of Osteoporosis: A Review of the Evidence and Suggested Guidelines for Its Use Endocr. Rev., August 1, 2005; 26(5): 688 - 703. [Abstract] [Full Text] [PDF]

				{blacktriangledown}Teriparatide for postmenopausal osteoporosis DTB, December 1, 2004; 42(12): 93 - 96. [Abstract] [Full Text] [PDF]

				G. R. Madore, P. J. Sherman, and J. M. Lane Parathyroid Hormone J. Am. Acad. Ortho. Surg., March 1, 2004; 12(2): 67 - 71. [Full Text] [PDF]

				S. A. Brown and J. L. Sharpless Osteoporosis: An Under-appreciated Complication of Diabetes Clin. Diabetes, January 1, 2004; 22(1): 10 - 20. [Abstract] [Full Text] [PDF]

				R. A. Adler and M. C. Hochberg Suggested Guidelines for Evaluation and Treatment of Glucocorticoid-Induced Osteoporosis for the Department of Veterans Affairs Arch Intern Med, November 24, 2003; 163(21): 2619 - 2624. [Abstract] [Full Text] [PDF]

				A. B. Hodsman, D. A. Hanley, M. P. Ettinger, M. A. Bolognese, J. Fox, A. J. Metcalfe, and R. Lindsay Efficacy and Safety of Human Parathyroid Hormone-(1-84) in Increasing Bone Mineral Density in Postmenopausal Osteoporosis J. Clin. Endocrinol. Metab., November 1, 2003; 88(11): 5212 - 5220. [Abstract] [Full Text] [PDF]

				D. M. Black, S. L. Greenspan, K. E. Ensrud, L. Palermo, J. A. McGowan, T. F. Lang, P. Garnero, M. L. Bouxsein, J. P. Bilezikian, C. J. Rosen, et al. The Effects of Parathyroid Hormone and Alendronate Alone or in Combination in Postmenopausal Osteoporosis N. Engl. J. Med., September 25, 2003; 349(13): 1207 - 1215. [Abstract] [Full Text] [PDF]

				S. Khosla Parathyroid Hormone plus Alendronate -- A Combination That Does Not Add Up N. Engl. J. Med., September 25, 2003; 349(13): 1277 - 1279. [Full Text] [PDF]

				M. J. Horwitz, M. B. Tedesco, C. Gundberg, A. Garcia-Ocana, and A. F. Stewart Short-Term, High-Dose Parathyroid Hormone-Related Protein as a Skeletal Anabolic Agent for the Treatment of Postmenopausal Osteoporosis J. Clin. Endocrinol. Metab., February 1, 2003; 88(2): 569 - 575. [Abstract] [Full Text] [PDF]

				C. Crandall Parathyroid Hormone for Treatment of Osteoporosis Arch Intern Med, November 11, 2002; 162(20): 2297 - 2309. [Abstract] [Full Text] [PDF]

				J. Reeve Recombinant human parathyroid hormone BMJ, February 23, 2002; 324(7335): 435 - 436. [Full Text] [PDF]

				E. Canalis and A. Giustina Glucocorticoid-Induced Osteoporosis: Summary of a Workshop J. Clin. Endocrinol. Metab., December 1, 2001; 86(12): 5681 - 5685. [Full Text] [PDF]

				E. F. Nemeth, E. G. Delmar, W. L. Heaton, M. A. Miller, L. D. Lambert, R. L. Conklin, M. Gowen, J. G. Gleason, P. K. Bhatnagar, and J. Fox Calcilytic Compounds: Potent and Selective Ca2+ Receptor Antagonists That Stimulate Secretion of Parathyroid Hormone J. Pharmacol. Exp. Ther., October 1, 2001; 299(1): 323 - 331. [Abstract] [Full Text] [PDF]

				N. R. Biermasz, N. A. T. Hamdy, Y. J. H. Janssen, and F. Roelfsema Additional Beneficial Effects of Alendronate in Growth Hormone (GH)-Deficient Adults with Osteoporosis Receiving Long-Term Recombinant Human GH Replacement Therapy: A Randomized Controlled Trial J. Clin. Endocrinol. Metab., July 1, 2001; 86(7): 3079 - 3085. [Abstract] [Full Text] [PDF]

				C. J. Rosen and J. P. Bilezikian Anabolic Therapy for Osteoporosis J. Clin. Endocrinol. Metab., March 1, 2001; 86(3): 957 - 964. [Abstract] [Full Text]

				J. Billiard, S. S. Grewal, L. Lukaesko, P. J. S. Stork, and P. Rotwein Hormonal Control of Insulin-like Growth Factor I Gene Transcription in Human Osteoblasts. DUAL ACTIONS OF cAMP-DEPENDENT PROTEIN KINASE ON CCAAT/ENHANCER-BINDING PROTEIN delta J. Biol. Chem., August 10, 2001; 276(33): 31238 - 31246. [Abstract] [Full Text] [PDF]