Impact of bisphosphonate wash-out prior to teriparatide therapy in clinical practice

• Published in: Journal of bone and mineral metabolism 2010-01, Vol.28 (1), p.68-76
• Main Authors: Keel, Christina, Kraenzlin, Marius E., Kraenzlin, Claude A., Müller, Beat, Meier, Christian
• Format: Article
• Language: English
• Subjects: Aged; Alendronate - therapeutic use; Alkaline Phosphatase - blood; Biological and medical sciences; Biomarkers - blood; Bone Density - drug effects; Bone Density Conservation Agents - adverse effects; Bone Density Conservation Agents - therapeutic use; Bone Regeneration - drug effects; Bone Resorption - prevention & control; Bones; Bones, joints and connective tissue. Antiinflammatory agents; Clinical medicine; Collagen Type I - blood; Diphosphonates - therapeutic use; Diseases of the osteoarticular system; Drug Interactions; Etidronic Acid - analogs & derivatives; Etidronic Acid - therapeutic use; Female; Fundamental and applied biological sciences. Psychology; Humans; Isoenzymes - blood; Male; Medical sciences; Medicine; Medicine & Public Health; Metabolic Diseases; Middle Aged; Organ Specificity; Original Article; Orthopedics; Osteocalcin - blood; Osteoporosis; Osteoporosis - blood; Osteoporosis - drug therapy; Osteoporosis - etiology; Osteoporosis. Osteomalacia. Paget disease; Peptides - blood; Pharmacology. Drug treatments; Risedronate Sodium; Skeleton and joints; Teriparatide - adverse effects; Teriparatide - therapeutic use; Time Factors; Vertebrates: osteoarticular system, musculoskeletal system
• ISSN: 0914-8779; 1435-5604
• DOI: 10.1007/s00774-009-0101-7

Concurrent use of bisphosphonate therapy reduces the anabolic effect of teriparatide. Consequently, in clinical practice bisphosphonates are discontinued and teriparatide therapy held for a few months to allow bone turnover to increase. We aimed to evaluate the effect of prior bisphosphonate exposure and the effect of bisphosphonate wash-out on the treatment response to teriparatide. Thirty-nine patients with primary osteoporosis (mean age 63.6 ± 14.0 years), including 26 patients previously treated with oral bisphosphonates (median duration 53 months) and 13 bisphosphonate-naïve patients were started on teriparatide (20 μg daily) and followed prospectively over 12 months. The primary study outcome was change in bone formation markers (PINP, bone ALP, osteocalcin). Secondary outcomes included changes in bone resorption (βCTX) and 12-month changes in BMD. Markers of bone formation increased early during teriparatide therapy and were followed by an increase in βCTX ( p