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Previous Volume 349:1216-1226 September 25, 2003 Number 13 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Editorial by Khosla, S. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background Because parathyroid hormone increases both bone formation and bone resorption, it is possible that combining parathyroid hormone with an antiresorptive agent will enhance its effect on bone mineral density.

Methods We randomly assigned 83 men who were 46 to 85 years of age and had low bone density to receive alendronate (10 mg daily; 28 men), parathyroid hormone (40 µg subcutaneously daily; 27 men), or both (28 men). Alendronate therapy was given for 30 months; parathyroid hormone therapy was begun at month 6. The bone mineral density of the lumbar spine, proximal femur, radial shaft, and total body was measured every six months with the use of dual-energy x-ray absorptiometry. Trabecular bone mineral density of the lumbar spine was measured at base line and month 30 by means of quantitative computed tomography. Serum alkaline phosphatase levels were measured every six months. The primary end point was the rate of change in the bone mineral density at the posteroanterior spine.

Results The bone mineral density at the lumbar spine increased significantly more in men treated with parathyroid hormone alone than in those in the other groups (P<0.001 for both comparisons). The bone mineral density at the femoral neck increased significantly more in the parathyroid hormone group than in the alendronate group (P<0.001) or the combination-therapy group (P=0.01). The bone mineral density of the lumbar spine increased significantly more in the combination-therapy group than in the alendronate group (P<0.001). At 12 months, changes in the serum alkaline phosphatase level were significantly greater in the parathyroid hormone group than in the alendronate group or the combination-therapy group (P<0.001 for both comparisons).

Conclusions Alendronate impairs the ability of parathyroid hormone to increase the bone mineral density at the lumbar spine and the femoral neck in men. This effect may be attributable to an attenuation of parathyroid hormone–induced stimulation of bone formation by alendronate.

Source Information

From the Endocrine Unit, Department of Medicine (J.S.F., A.H., J.L.H., J.J.W., R.M.N.), and the Biostatistics Center (H.L.), Massachusetts General Hospital, Boston.

This article was published at www.nejm.org on September 20, 2003.

Address reprint requests to Dr. Finkelstein at the Endocrine Unit, Bulfinch 327, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, or at jfinkelstein{at}partners.org.

Full Text of this Article

Related Letters:

Effects of Parathyroid Hormone and Alendronate Alone or in Combination in Osteoporosis
Vegni F. E., Corradini C., Privitera G., Sugiyama T., Tanaka H., Kawai S., Miller P. D., Fuller K. E., Black D. M., Bilezikian J., Rosen C. J., the PaTH (Parathyroid Hormone and Alendronate) Study Investigators , Finkelstein J. S., Neer R. M.
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N Engl J Med 2004; 350:189-192, Jan 8, 2004. Correspondence

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