Effects of intravenous zoledronic acid plus subcutaneous teriparatide [rhPTH(1–34)] in postmenopausal osteoporosis

Cosman, Felicia; Eriksen, Erik Fink; Recknor, Chris; Miller, Paul D.; Guañabens, Núria; Kasperk, Christian; Papanastasiou, P.; Readie, Aimee; Rao, Hanumantha; Gasser, Jürg A.; Bucci‐Rechtweg, Christina; Boonen, Steven

doi:10.1002/jbmr.238

Cited by 319 publications

(188 citation statements)

References 45 publications

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“…As shown in Figure. 1A, of the 175 studies originally identified and screened, eight studies [3,12,[22][23][24][25][26][27] were included in the meta-analysis. Of those, two studies included patients with GIO, and the remaining six involved patients with PO (Table 1).…”

Section: Resultsmentioning

confidence: 99%

“…The P values with these studies removed were borderline, indicating no obvious influence of any individual study on the pooled estimate. The heterogeneity observed may also be due to the different types of bisphosphonates used among the included studies (only Hadji et al [23] used risedronate and Cosman et al [25] used zoledronic acid), or selection bias or bias from intent-to-treat analysis in the three studies which evaluated vertebral fractures (McClung et al [24], Saag et al [3] and Body et al [27]). …”

Section: Discussionmentioning

confidence: 99%

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Head-to-head comparisons of bisphosphonates and teriparatide in osteoporosis: a meta-analysis

Liu

Lee

Chen

et al. 2017

CIM

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Head-to-head comparisons of bisphosphonates and teriparatide in osteoporosis: a meta-analysis Abstract Purpose: This meta-analysis aimed to compare the efficacy and safety of teriparatide vs. bisphosphonates in the management of osteoporosis.Methods: A total of 1,967 patients from eight randomized controlled trials were analyzed; outcomes included bone mineral density (BMD) of the femoral neck, total hip and lumbar spine, vertebral and nonvertebral fractures and any adverse event. A subgroup analysis of treatment effectiveness was performed according to the etiology of osteoporosis; i.e., glucocorticoid-induced osteoporosis (GIO) vs. post-menopausal osteoporosis (PO).Results: Teriparatide increased the BMD of the lumbar spine, femoral neck and total hip to a greater extent than bisphosphonates. Patients treated with teriparatide also had a lower risk of vertebral fractures compared with bisphosphonates; however, no difference in risk of nonvertebral fractures (or adverse events) was found. GIO subgroups showed larger increases in BMD of the lumbar spine, total hip and femoral neck in patients treated with teriparatide compared with bisphosphonates. The PO subgroup showed larger increases in BMD of the lumbar spine in patients treated with teriparatide compared with bisphosphonates. Patients in the GIO subgroup (but not the PO subgroup) were less likely to suffer a vertebral fracture on teriparatide as compared with bisphosphonates. In contrast, no significant difference in the percentage of nonvertebral fractures was noted between the two types of treatment for either subgroup. Conclusion:Teriparatide significantly increased the BMD of lumbar spine, total hip and femoral neck, particularly in GIO-induced osteoporosis. Teriparatide did not lower the risk of nonvertebral fractures when compared with bisphosphonates.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Head-to-head comparisons of bisphosphonates and teriparatide in osteoporosis: a meta-analysis

Liu

Lee

Chen

et al. 2017

CIM

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“…Several studies have been performed with different combinations of antiresorptive and anabolic drugs, to evaluate their potential additive, synergistic effects on bone metabolism, bone volume, and BMD. (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26) Antiresorptives, depending on their potency, differentially influence the dynamic changes in bone formation and resorption that are induced by TPTD. In one study, raloxifene (RAL), when combined with TPTD, did not impair TPTD-induced stimulation of bone formation.…”

Section: Introductionmentioning

confidence: 99%

Antiresorptives overlapping ongoing teriparatide treatment result in additional increases in bone mineral density

Muschitz¹,

Kocijan²,

Fahrleitner‐Pammer

et al. 2012

Journal of Bone and Mineral Research

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During teriparatide (TPTD) treatment, high levels of bone formation are accompanied by an increase in bone resorption. The aim of this work was to test if coadministration of raloxifene (RAL) or alendronate (ALN) following 9 months of ongoing TPTD therapy would reopen the anabolic window, thereby exerting additional benefit on bone mineral density (BMD). Postmenopausal women (n ¼ 125) with severe osteoporosis on TPTD treatment for 9 months were randomized into three open-label groups for a further 9 months: ALN (70 mg/week) in addition to TPTD; RAL (60 mg/d) in addition to TPTD; or no medication in addition to TPTD. Amino-terminal propeptide of type I procollagen (P1NP) and cross-linked C-telopeptide (CTX), and areal and volumetric BMD at the lumbar spine and hip were assessed. During the combination period, P1NP concentrations did not change on TPTD monotherapy (693% AE 371%, p < 0.0001) and decreased in the ALN (360% AE 153%, p < 0.0001) and RAL (482% AE 243%, p < 0.0001) combination groups; whereas CTX did not change on TPTD monotherapy (283% AE 215%, p < 0.0001), decreased to the starting level in the ALN combination group (17% AE 72%, p ¼ 0.39), and remained elevated in the RAL combination group (179% AE 341%, p < 0.0001). The increase in lumbar spine BMD was 5% AE 6.3% in the ALN and 6% AE 5.2% in the RAL combination groups compared with 2.8% AE 9.3% in the TPTD monotherapy group (p ¼ 0.085 and p ¼ 0.033, respectively). The increase of trabecular lumbar spine BMD for both the ALN and RAL combination groups was superior to TPTD monotherapy. Total hip BMD changes were 4% AE 5.3% for the ALN combination group and 1.4% AE 5.1% for the TPTD monotherapy (p ¼ 0.032), and 1.4% AE 3.4% (p ¼ 0.02) for the RAL combination group. With the exception of no differences in the trabecular compartment of femoral neck, volumetric BMD changes in the ALN combination group for all other comparisons were significantly superior to the two other groups. Our data suggest that ALN when added to TPTD 9 months after initiation of TPTD monotherapy results in a more robust increase in BMD, probably due to a reopening of the anabolic window. The clinical relevance of the BMD increase is unknown. ß

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“…With combination therapy, there was a rapid, but transient, reduction in CTX during the first 2 months, with a subsequent and gradual increase with levels remaining above baseline for last 6 months of the study. Levels of both markers were significantly lower with combination therapy versus teriparatide alone (p < 0.002) (41).…”

Section: Pthmentioning

confidence: 93%

Bone markers and osteoporosis therapy

Bandeira

Costa

Filho

et al. 2014

Arq Bras Endocrinol Metab

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Several factors are involved in determining bone quality including bone density, bone turnover, the extent of trabecular bone connectivity, cortical porosity and geometry. Metabolically active and in a continuous process of remodeling, approximately 20% of bone tissue is renewed annually. Bone turn over markers (BTM) are frequently used in clinical trials and to provide valid information about the effectiveness of osteoporosis treatment, reflecting the state of bone metabolism and its response to treatment, although they are not useful alone to estimate bone loss. In this review the behavior of BTM from different clinical trials or different osteoporotic drugs will be addressed. Arq Bras Endocrinol Metab. 2014;58(5):504-13 Keywords Bone markers; osteoporosis; bone density ReSumoDiversos fatores estão envolvidos na determinação da qualidade óssea, incluindo a densidade óssea, a remodelação óssea, a extensão da conectividade do osso trabecular, porosidade cortical e geometria. Metabolicamente ativo e, em um processo contínuo de remodelação, cerca de 20% do tecido ósseo é renovado anualmente. Por sua vez, marcadores de turnover ósseo (BTM) são frequentemente utilizados em estudos clínicos e fornecem informações válidas sobre a eficácia do tratamento da osteoporose, o que reflete o metabolismo ósseo e sua resposta ao tratamento, embora eles não sejam úteis somente para estimar a perda óssea. Nesta revisão, o comportamento dos BTM em ensaios clínicos diferentes e com diferentes drogas osteoporóticas será abordado. one is a specific type of tissue composed primarily of type I collagen impregnated with minerals in the form of hydroxyapatite crystals. Several factors are involved in determining bone quality including bone density, bone turnover, the extent of trabecular bone connectivity, cortical porosity and geometry (Figure 1) (1). Metabolically active and in a continuous process of remodeling, approximately 20% of bone tissue is renewed annually (2). This complex process begins at birth and is maintained throughout life. The active cellular participants in this process, often configured as multiple multicellular units, are osteoclasts, osteoblasts and osteocytes.The system is highly regulated by many factors. For example, osteoprotegerin (OPG) (osteoprotegerin), receptor activator of NF-kappaB (RANK) and its cognate ligand, (RANKL), form a metabolic regulatory system focused upon bone resorption (3). Additionally there are other factors that influence bone turnover, such as parathyroid hormone (PTH), 1,25-dihydroxyvitamin D (calcitriol), prostaglandin E2 and interleukins (4). The process of bone turnover leads to the release of factors that give highly relevant information on rates of bone formation and resorption (Figure 2).

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Effects of intravenous zoledronic acid plus subcutaneous teriparatide [rhPTH(1–34)] in postmenopausal osteoporosis

Cited by 319 publications

References 45 publications

Head-to-head comparisons of bisphosphonates and teriparatide in osteoporosis: a meta-analysis

Head-to-head comparisons of bisphosphonates and teriparatide in osteoporosis: a meta-analysis

Antiresorptives overlapping ongoing teriparatide treatment result in additional increases in bone mineral density

Bone markers and osteoporosis therapy

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