Abstract
An increase in procollagen type I amino-terminal propeptide (PINP) early after teriparatide initiation was shown to correlate with increased lumbar spine areal BMD and is a good predictor of the anabolic response to teriparatide. Few data exist correlating PINP and bone microstructure, and no data exist in patients on teriparatide following prior potent antiresorptive treatment. This exploratory analysis aimed to investigate the effects of teriparatide on cancellous bone microstructure and correlations of bone markers with microstructure in alendronate-pretreated patients. This was a post hoc analysis of changes in bone markers and three-dimensional indices of bone microstructure in paired iliac crest biopsies from a prospective teriparatide treatment study in postmenopausal women with osteoporosis who were either treatment-naïve (TN, n=16) or alendronate-pretreated (ALN, n=29) at teriparatide initiation. Teriparatide (20μg/day) was given for 24months; biopsies were taken at baseline and endpoint, and serum concentrations of PINP and type 1 collagen cross-linked C-telopeptide (βCTX) were measured at intervals up to 24months. In the TN and ALN groups, respectively, mean (SD) increases in three-dimensional bone volume/tissue volume were 105 (356)% (P=0.039) and 55 (139)% (P<0.005) and trabecular thickness 30.4 (30)% (P<0.001) and 30.8 (53)% (P<0.001). No significant changes were observed in trabecular number or separation. In the ALN patients, 3-month change of neither PINP nor βCTX correlated with indices of cancellous bone microstructure. However, 12-month changes in biochemical bone markers correlated significantly with improvements in bone volume/tissue volume, r=0.502 (P<0.01) and r=0.378 (P<0.05), trabecular number, r=0.559 (P<0.01) and r=0.515 (P<0.01), and reduction of trabecular separation, r=−0.432 (P<0.05) and r=−0.530 (P<0.01), for PINP and βCTX, respectively. We conclude that cancellous bone microstructure improved with teriparatide therapy irrespective of prior antiresorptive use.
Highlights
Teriparatide treatment stimulates bone formation and reduces fracture rates in postmenopausal women with osteoporosis [1,2]
The aim of this analysis was to investigate the effects of teriparatide on cancellous bone microstructure, either with or without alendronate pretreatment, and to examine the correlations between bone markers and microstructure in patients pretreated with alendronate as a means to predict patient response to treatment
Patients pretreated with alendronate, for a minimum of 34 months to a maximum of 93 months, had significantly greater lumbar spine BMD and significantly lower concentrations of the bone turnover markers than the treatment-naïve patients, as expected with long-term bisphosphonate treatment
Summary
Teriparatide treatment stimulates bone formation and reduces fracture rates in postmenopausal women with osteoporosis [1,2]. The increase in BMD is associated with various structural improvements resulting in improved biomechanical properties of the bone [3,4,5,6,7]. Teriparatide rapidly increases biochemical markers of bone formation, followed by an increase of resorption markers, and data suggest that the increases in biochemical markers correlate with indices of. Increase of PINP after the initiation of teriparatide treatment has been demonstrated to positively correlate with the increase of lumbar spine areal BMD [8,9,15]. PINP response has been proposed to be predictive for the individual bone-building capability of teriparatide
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
