Differential effects of teriparatide and alendronate on bone remodeling in postmenopausal women assessed by histomorphometric parameters. 2005

Monique Arlot, and Pierre J Meunier, and Georges Boivin, and Lillian Haddock, and Juan Tamayo, and Ricardo Correa-Rotter, and Salomón Jasqui, and David W Donley, and Gail P Dalsky, and Javier San Martin, and Erik Fink Eriksen
Laboratoire d'Histodynamique Osseuse and INSERM Unit 403, Faculty of Medicine R. Laennec, Lyon, France. Monique.Arlot@sante.univ-lyon1.fr

An 18-month randomized double-blind study was conducted in postmenopausal women with osteoporosis to compare the effects of once-daily teriparatide 20 microg with alendronate 10 mg on bone histomorphometry. Biopsies were obtained from 42 patients. Indices of bone formation were significantly higher after 6 or 18 months of teriparatide compared with alendronate treatment. BACKGROUND Alendronate and teriparatide increased BMD, assessed by DXA, by different mechanisms of action, supported by changes in biochemical markers of bone turnover. The purpose of this cross-sectional study was to explore the differential effects of these two osteoporosis treatments at the bone tissue level by examining bone histomorphometric parameters of bone turnover after either 6 or 18 months of treatment. METHODS Patients were a cohort from a randomized parallel double-blind study conducted to compare the effects of once-daily teriparatide 20 microg and alendronate 10 mg in postmenopausal women with osteoporosis. Transiliac crest bone biopsies were obtained after tetracycline double labeling from 42 patients treated for 6 months (n = 23) or 18 months (n = 14); 5 additional patients were biopsied from contralateral sides at 6 and 18 months. Biopsy specimens adequate for quantitative analysis were analyzed by 2D histomorphometry from 17 patients at 6 months (teriparatide, n = 8; alendronate, n = 9) and 15 patients at 18 months (teriparatide, n = 8; alendronate, n = 7). Data were analyzed by two-sample tests. RESULTS Histomorphometric indices of bone formation were significantly and markedly greater in the teriparatide group than in the alendronate group at 6 and 18 months, whereas indices of bone resorption were only significantly greater in the teriparatide group than in the alendronate group at 6 months. Bone formation and activation frequency were significantly lower at 18 months compared with 6 months in the teriparatide group, returning to levels comparable with untreated postmenopausal women. In the teriparatide group, the peak in histomorphometric bone formation indices coincided with peak levels for N-terminal propeptide of type I collagen, a biochemical marker of bone formation. The degree of mineralization was lower at 18 months than at 6 months with treatment in both groups but was not different between groups. CONCLUSIONS These results confirm the opposite mechanisms of action of teriparatide and alendronate on bone remodeling and confirm the bone formation effect of teriparatide.

UI MeSH Term Description Entries
D007085 Ilium The largest of three bones that make up each half of the pelvic girdle. Auricular Surface of Ilium,Iliac Crest,Iliac Crest Bone,Iliac Fossa,Bones, Iliac Crest,Crest Bone, Iliac,Crest Bones, Iliac,Crest, Iliac,Crests, Iliac,Fossa, Iliac,Iliac Crest Bones,Iliac Crests,Iliums
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D002113 Calcification, Physiologic Process by which organic tissue becomes hardened by the physiologic deposit of calcium salts. Bone Mineralization,Calcification, Physiological,Physiologic Calcification,Mineralization, Bone,Physiological Calcification
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000368 Aged A person 65 years of age or older. For a person older than 79 years, AGED, 80 AND OVER is available. Elderly
D015415 Biomarkers Measurable and quantifiable biological parameters (e.g., specific enzyme concentration, specific hormone concentration, specific gene phenotype distribution in a population, presence of biological substances) which serve as indices for health- and physiology-related assessments, such as disease risk, psychiatric disorders, ENVIRONMENTAL EXPOSURE and its effects, disease diagnosis; METABOLIC PROCESSES; SUBSTANCE ABUSE; PREGNANCY; cell line development; EPIDEMIOLOGIC STUDIES; etc. Biochemical Markers,Biological Markers,Biomarker,Clinical Markers,Immunologic Markers,Laboratory Markers,Markers, Biochemical,Markers, Biological,Markers, Clinical,Markers, Immunologic,Markers, Laboratory,Markers, Serum,Markers, Surrogate,Markers, Viral,Serum Markers,Surrogate Markers,Viral Markers,Biochemical Marker,Biologic Marker,Biologic Markers,Clinical Marker,Immune Marker,Immune Markers,Immunologic Marker,Laboratory Marker,Marker, Biochemical,Marker, Biological,Marker, Clinical,Marker, Immunologic,Marker, Laboratory,Marker, Serum,Marker, Surrogate,Serum Marker,Surrogate End Point,Surrogate End Points,Surrogate Endpoint,Surrogate Endpoints,Surrogate Marker,Viral Marker,Biological Marker,End Point, Surrogate,End Points, Surrogate,Endpoint, Surrogate,Endpoints, Surrogate,Marker, Biologic,Marker, Immune,Marker, Viral,Markers, Biologic,Markers, Immune
D015502 Absorptiometry, Photon A noninvasive method for assessing BODY COMPOSITION. It is based on the differential absorption of X-RAYS (or GAMMA RAYS) by different tissues such as bone, fat and other soft tissues. The source of (X-ray or gamma-ray) photon beam is generated either from radioisotopes such as GADOLINIUM 153, IODINE 125, or Americanium 241 which emit GAMMA RAYS in the appropriate range; or from an X-ray tube which produces X-RAYS in the desired range. It is primarily used for quantitating BONE MINERAL CONTENT, especially for the diagnosis of OSTEOPOROSIS, and also in measuring BONE MINERALIZATION. Absorptiometry, X-Ray,Dual-Photon Absorptiometry,Photodensitometry, X-Ray,Photon Absorptiometry,Single-Photon Absorptiometry,X-Ray Absorptiometry,Absorptiometry, Dual X-Ray,Absorptiometry, Dual-Energy Radiographic,Absorptiometry, Dual-Energy X-Ray,DEXA Scan,DPX Absorptiometry,DXA Scan,Densitometry, X-Ray,Densitometry, Xray,Dual X-Ray Absorptiometry,Dual-Energy Radiographic Absorptiometry,Dual-Energy X-Ray Absorptiometry,Dual-Energy X-Ray Absorptiometry Scan,Radiographic Absorptiometry, Dual-Energy,X-Ray Absorptiometry, Dual-Energy,X-Ray Photodensitometry,Absorptiometries, DPX,Absorptiometry, DPX,Absorptiometry, Dual Energy Radiographic,Absorptiometry, Dual Energy X Ray,Absorptiometry, Dual X Ray,Absorptiometry, Dual-Photon,Absorptiometry, Single-Photon,Absorptiometry, X Ray,DEXA Scans,DXA Scans,Densitometry, X Ray,Dual Energy Radiographic Absorptiometry,Dual Energy X Ray Absorptiometry,Dual Energy X Ray Absorptiometry Scan,Dual Photon Absorptiometry,Dual X Ray Absorptiometry,Photodensitometry, X Ray,Radiographic Absorptiometry, Dual Energy,Scan, DEXA,Scan, DXA,Scans, DEXA,Scans, DXA,Single Photon Absorptiometry,X Ray Absorptiometry,X Ray Absorptiometry, Dual Energy,X Ray Photodensitometry,X-Ray Absorptiometry, Dual,X-Ray Densitometry,Xray Densitometry
D015519 Bone Density The amount of mineral per square centimeter of BONE. This is the definition used in clinical practice. Actual bone density would be expressed in grams per milliliter. It is most frequently measured by X-RAY ABSORPTIOMETRY or TOMOGRAPHY, X RAY COMPUTED. Bone density is an important predictor for OSTEOPOROSIS. Bone Mineral Content,Bone Mineral Density,Bone Densities,Bone Mineral Contents,Bone Mineral Densities,Density, Bone,Density, Bone Mineral
D015663 Osteoporosis, Postmenopausal Metabolic disorder associated with fractures of the femoral neck, vertebrae, and distal forearm. It occurs commonly in women within 15-20 years after menopause, and is caused by factors associated with menopause including estrogen deficiency. Bone Loss, Perimenopausal,Bone Loss, Postmenopausal,Perimenopausal Bone Loss,Postmenopausal Bone Loss,Postmenopausal Osteoporosis,Osteoporosis, Post-Menopausal,Bone Losses, Perimenopausal,Bone Losses, Postmenopausal,Osteoporoses, Post-Menopausal,Osteoporoses, Postmenopausal,Osteoporosis, Post Menopausal,Perimenopausal Bone Losses,Post-Menopausal Osteoporoses,Post-Menopausal Osteoporosis,Postmenopausal Bone Losses,Postmenopausal Osteoporoses

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