Mapping bone changes at the proximal femoral cortex of postmenopausal women in response to alendronate and teriparatide alone, combined or sequentially
Journal of Bone and Mineral Research
MetadataShow full item record
Whitmarsh, T., Treece, G., Gee, A., & Poole, K. (2015). Mapping bone changes at the proximal femoral cortex of postmenopausal women in response to alendronate and teriparatide alone, combined or sequentially. Journal of Bone and Mineral Research, 30 1309-1318. https://doi.org/10.1002/jbmr.2454
Combining anti-resorptive and anabolic drugs for osteoporosis may be a useful strategy to prevent hip fractures. Previous studies comparing the effects of alendronate and teriparatide alone, combined or sequentially using Quantitative Computed Tomography (QCT) in postmenopausal women have not distinguished cortical bone mineral density (CBMD) from cortical thickness (CTh) effects, nor assessed the distribution and extent of more localised changes. In this study a validated bone mapping technique was used to examine the cortical and endocortical trabecular changes in the proximal femur resulting from an 18 month course of alendronate or teriparatide. Using QCT data from a different clinical trial, the global and localised changes seen following a switch to teriparatide after an 18 month alendronate treatment or adding teriparatide to the alendronate treatment were compared. CTh increased (4.8%, p < 0.01) and CBMD decreased (-4.5%, p < 0.01) in the teriparatide group compared to no significant change in the alendronate group. A large CTh increase could be seen for the switch group (2.8%, p < 0.01) compared to a significantly smaller increase for the add group (1.5%, p < 0.01). CBMD decreased significantly for the switch group (-3.9%, p < 0.01) and was significantly different from no significant change in the add group. CTh increases were shown to be significantly greater for the switch group compared to the add group at the load bearing regions. This study provides new insights into the effects of alendronate and teriparatide combination therapies on the cortex of the proximal femur and supports the hypothesis of an increased bone remodelling by teriparatide being mitigated by alendronate.
Alendronate, Teriparatide, QCT, Cortical thickness, BMD
External DOI: https://doi.org/10.1002/jbmr.2454
This record's URL: https://www.repository.cam.ac.uk/handle/1810/247213