Abstract
The skeletal effects of glucocorticoids include both direct and indirect actions on bone that result early, transient in bone resorption accompanied by a decrease in bone formation, which is maintained for the duration of glucocorticoid therapy. Teriparatide exerts anabolic effects on bone, so it is understandable why teriparatide is thought to be a rational treatment option. The effects of 36 months' treatment with teriparatide and alendronate in women and men with glucocorticoid-induced osteoporosis were examined in an active-comparator randomized, double-blind, controlled trial. This study confirmed the superiority of teriparatide over alendronate with respect BMD changes in the spine and hip and significantly reduced risk of vertebral fractures in teriparatide-treated patients. However, because teriparatide is significantly more expensive than bisphosphonates and has not been demonstrated in adequately powered studies to be superior in reducing fractures, bisphosphonates remain the first-line treatment option for the majority of glucocorticoid-treated patients at increased risk of fracture.
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