 medico |
Anabolic treatment with teriparatide of postmenopausal osteoporotic patients previously treated with bisphosphonates is a new therapeutic approach. However its effects on the bone mineralization density distribution (BMDD) are unknown. We studied paired transiliacal bone biopsy samples taken before and after one year treatment with recombinant human parathyroid hormone peptide 1-34 (teriparatide) from 16 osteoporotic women treated with either alendronate (priorALN) or risedronate (priorRIS) for at least 2 years and subsequently treated 12 months with teriparatide. Cancellous (Cn.) and cortical (Ct.) BMDD was measured using quantitative backscattered electron imaging. At baseline, BMDD of priorALN and priorRIS were similar and within the normal range. One year teriparatide treatment caused significant effects on the BMDD. Analyzing changes from baseline for each bisphosphonate group separately, priorALN patients revealed increases in the portion of low mineralized bone areas (Cn.CaLow +25.9%, Ct.CaLow +62.0%, both p<0.05) and Ct. heterogeneity of mineralization (Ct.CaWidth +22.8%, p<0.001). PriorRIS patients showed increased mineralization heterogeneity (Cn. CaWidth +14.8%, p<0.05 and Ct.CaWidth +15.8%, p<0.001). Analysis of the influence of the prior bisphosphonate treatment showed that the BMDD response to one year teriparatide treatment was not dependent on the type of prior bisphosphonate. In consequence, priorALN and priorRIS groups were combined. The pooled groups revealed increased Cn. and Ct. CaWidth (+10.7%, p<0.01; +19.6%, p<0.001, respectively) as well as increased Cn. and Ct. CaLow (+18.2%, p<0.05; +36.6%, p<0.01, respectively). In summary, our findings indicate a significant effect of teriparatide on the BMDD when administered subsequently to a bisphosphonate in agreement with teriparatide's anabolic action. (c) 2010 American Society for Bone and Mineral Research. Misof BM, Paschalis EP, Blouin S, Fratzl-Zelman N, Klaushofer K, Roschger P. J Bone Miner Res. 2010 Aug 3. [Epub ahead of print] |
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