Men's Osteoporosis Support GroupTeriparatide vs. alendronate in glucocorticoid osteoporosis Osteoporos Int. 2009 Apr 7. [Epub ahead of print] . Teriparatide versus alendronate for treating glucocorticoid-induced osteoporosis: an analysis by gender and menopausal status. Langdahl BL and others. PMID: 19350340. This study involved 277 postmenopausal women, 67 premenopausal women, 83 men who had glucocorticoid-induced osteoporosis (GIO). The purpose was to evaluate the effect of teriparatide (Forteo), 20 microg/day, vs. alendronate (Fosamax), 10 mg/day, for 18 months. Primary outcome was change in lumbar spine BMD. Secondary outcomes included change in hip BMD, change in bone biomarkers, fracture incidence, and safety. The results showed that teriparatide was significantly better than alendronate in increasing lumbar spine bone mineral density (BMD) in all groups. The authors concluded: "Among men and pre- and postmenopausal women with GIO, lumbar spine BMD increased more in patients receiving teriparatide compared with alendronate." Editor's comments. There were more spinal fractures in the alendronate groups and more non-vertebral fractures in the teriparatide groups. I don't have the full article, but this might be due to a couple of possibilities: spinal fractures can occur without a fall, simply due to the weakness in the bone finally causing it to compress. Since the teriparatide works quickly to increase BMD, one would expect faster prevention of fractures too. The alendronate not only works more slowly, but didn't improve BMD nearly as much, thus more vertebral fractures would be logical in the alendronate groups. The non-vertebral fractures most likely occurred to the hip or wrist from falls and involved about the same number of fractures for either medication. That is also to be expected since improvements in BMD were probably not enough to stop a bone from fracturing from a fall, particularly earlier in the study. And falls should have occurred in about equal numbers among all groups in the study. There were big differences in the increase in BMD in the teriparatide groups which could be very important in individuals who have GIO. Possibly they were not detected to have osteoporosis until it is quite severe, thus there is a great need to improve the BMD quickly and as much as possible. This is exactly what the teriparatide does, and thus would appear to be the best choice for these at-risk individuals. Later they can switch to one of the bisphosphonates once their BMD is back in the osteopenia or normal range. Bottom line: If you have GIO ask your physician about an 18-month period using teriparatide.
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