Men's Osteoporosis Support Group

Two teriparatide studies

Arthritis Rheum. 2009 Oct 29;60(11):3346-3355. [Epub ahead of print]. Effects of teriparatide versus alendronate for treating glucocorticoid-induced osteoporosis: Thirty-six-month results of a randomized, double-blind, controlled trial. Saag KG and others. PMID: 19877063. This study compared the effectiveness of 20 mug/day teriparatide (Forteo) or 10 mg/day of alendronate (Fosamax) in 428 individuals aged 22-89 years who had received >/=5 mg/day of prednisone equivalent for >/=3 months preceding screening. Increases in BMD after 36 months in the spine, total hip and femoral neck were approximately double that of alendronate group for the teriparatide group. Additionally there were fewer spinal fractures in the teriparatide group, but no significant difference in nonvertebral fractures between the two groups. The authors conclude: "Our findings indicate that subjects with glucocorticoid-induced OP treated with teriparatide for 36 months had greater increases in BMD and fewer new vertebral fractures than subjects treated with alendronate."

Editor's comments: There was a really big difference in the increase in BMD in the teriparatide group compared to the alendronate group. This has been shown in other studies, too. See this Update for details. The interesting finding is that there was no difference in nonvertebral fracture rate even though hip BMD increased about double in the teriparatide group compared to the alendronate group. Since osteoporosis is defined as a condition of low BMD, it would be assumed that individuals who had the greatest increase in BMD would have fewer fractures. We don't know the ages of those who fractured. That might be telling if all were very elderly persons more susceptible to falling. And we don't know the starting BMD of the individuals that had fractures. If they were the subjects with the greatest loss of BMD, that would make sense. Perhaps later studies will shed some light on this question. Meanwhile, this study definitely shows that if increased BMD is your goal, teriparatide is preferable to alendronate. It does require a daily injection whereas several forms of bisphosphonates, of which alendronate is just one example, can be taken on a once-weekly, once-monthly or once-yearly basis. The next article will be the first demonstration I've seen that a daily transdermal patch may be an alternative to daily injections for teriparatide.

J Clin Endocrinol Metab. 2009 Oct 26. [Epub ahead of print]. Effect of Transdermal Teriparatide Administration on Bone Mineral Density in Postmenopausal Women. Cosman F and others. PMID: 19858319. This was a six-month study of teriparatide (TPTD) used on 165 postmenopausal women as a daily transdermal patch in three doses: 20-, 30-, or 40-mug or compared to a placebo patch and 20-mug injections of TPTD. Results showed TPTD delivered by transdermal patch significantly increased lumbar spine BMD vs. placebo patch in a dose-dependent manner at 6 months (P < 0.001. The authors concluded: "Transdermal patch delivery of TPTD in postmenopausal women with osteoporosis for 6 months is safe and effective in increasing lumbar spine and total hip BMD."

Editor's comments. These results are quite interesting and show that the daily transdermal patch may become an alternative to the daily injections of TPTD. This would be helpful on a couple of fronts: the injections require careful refrigerated shipping and must be refrigerated at home until used, and most people prefer a transdermal patch to a self-administered injection--at least I know that I do for testosterone therapy. So continue to watch as further trials are done using the transdermal patch. If they are effective this could lead to FDA approval of this osteoporosis treatment method.

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