Bisphosphonate Pre-Treatment Diminishes the Therapeutic Benefits of Teriparatide in Japanese Osteoporotic Patients

Bisphosphonate Pre-Treatment Diminishes the Therapeutic Benefits of Teriparatide in Japanese Osteoporotic Patients

MIKIO KAMIMURA,¹ YUKIO NAKAMURA,^2,3 SHOTA IKEGAMI,² SHIGEHARU UCHIYAMA² and HIROYUKI KATOV²

¹Center for Osteoporosis and Spinal Disorders, Kamimura Orthopaedic Clinic, Matsumoto, Nagano, Japan
²Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
³Department of Orthopaedic Surgery, Showa-Inan General Hospital, Komagane, Nagano, Japan

Osteoporosis (OP) is the most common multifactorial metabolic bone disorder worldwide. It remains unclear whether bisphosphonate (BP) pre-treatment affects the anabolic bone metabolism in OP patients treated with teriparatide (TPTD), a recombinant form of parathyroid hormone 1-34. This study is the first to evaluate the clinical outcomes of daily TPTD administration in Japanese OP patients and aimed to clarify how BP pre-treatment influences the efficacy of TPTD. We enrolled 112 patients diagnosed as primary OP who received TPTD. Subjects were classified as OP treatment-naiuml;ve patients (TPTD alone group) or patients previously treated with BP (BP pre-treated group). We measured serum bone-specific alkaline phosphatase (BAP) as a bone formation marker, urinary cross-linked N-terminal telopeptide of type I collagen (NTX) as a bone resorption marker, and bone mineral density (BMD) of lumbar vertebrae (L-BMD) and bilateral total hips (H-BMD). In both groups, BAP and NTX increased until 6 months and then decreased thereafter. The percent changes of both markers in BP pre-treated group were more increased than those in TPTD alone group. L-BMD increased significantly in both groups. Thepercent increase of L-BMD in the TPTD alone group was significantly higher than that in the BP pre-treated group. H-BMD rose significantly in the TPTD alone group, but not in BP pre-treated group. BP pre-treatment appears to diminish the degree of the TPTD-mediated increase in BMD. Thus, it is preferable to administer TPTD ahead of BP treatment in patients with severe OP.

keywords —— bisphosphonate; bone mineral density; bone turnover markers; Japanese osteoporotic patients; teriparatide

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Tohoku J. Exp. Med., 2016, 239, 17-24

Correspondence: Yukio Nakamura, M.D., Ph.D., Department of Orthopaedic Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, Nagano 390-8621, Japan.

e-mail: yxn14@aol.jp