Bisphosphonate therapy is the current standard ofcare for the prevention and treatment of glucocorticoid-inducedosteoporosis. Studies of anabolic therapy in patients who arereceiving long-term glucocorticoids and are at high risk forfracture are lacking.

In an 18-month randomized, double-blind, controlledtrial, we compared teriparatide with alendronate in 428 womenand men with osteoporosis (ages, 22 to 89 years) who had receivedglucocorticoids for at least 3 months (prednisone equivalent,5 mg daily or more). A total of 214 patients received 20 µgof teriparatide once daily, and 214 received 10 mg of alendronateonce daily. The primary outcome was the change in bone mineraldensity at the lumbar spine. Secondary outcomes included changesin bone mineral density at the total hip and in markers of boneturnover, the time to changes in bone mineral density, the incidenceof fractures, and safety.

At the last measurement, the mean (±SE) bonemineral density at the lumbar spine had increased more in theteriparatide group than in the alendronate group (7.2±0.7%vs. 3.4±0.7%, P<0.001). A significant difference betweenthe groups was reached by 6 months (P<0.001). At 12 months,bone mineral density at the total hip had increased more inthe teriparatide group. Fewer new vertebral fractures occurredin the teriparatide group than in the alendronate group (0.6%vs. 6.1%, P=0.004); the incidence of nonvertebral fractureswas similar in the two groups (5.6% vs. 3.7%, P=0.36). Significantlymore patients in the teriparatide group had at least one elevatedmeasure of serum calcium.

Among patients with osteoporosis who were at highrisk for fracture, bone mineral density increased more in patientsreceiving teriparatide than in those receiving alendronate.

Source: The New England Journal of Medicine 357:2028-2039