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Previous Volume 353:555-565 August 11, 2005 Number 6 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Supplementary Material Editorial by Heaney, R. P. 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 Since the use of parathyroid hormone as a treatment for osteoporosis is limited to two years or less, the question of whether antiresorptive therapy should follow parathyroid hormone therapy is important. We previously reported results after the first year of this randomized trial comparing the use of full-length parathyroid hormone (1–84) alone, alendronate alone, or both combined. In the continuation of this trial, we asked whether antiresorptive therapy is required to maintain gains in bone mineral density after one year of therapy with parathyroid hormone (1–84).

Methods In the data reported here, women who had received parathyroid hormone (1–84) monotherapy (100 µg daily) in year 1 were randomly reassigned to one additional year with either placebo (60 subjects) or alendronate (59 subjects). Subjects who had received combination therapy in year 1 received alendronate in year 2; those who had received alendronate monotherapy in year 1 continued with alendronate in year 2. Bone mineral density at the spine and hip was assessed with the use of dual-energy x-ray absorptiometry and quantitative computed tomography (CT).

Results Over two years, alendronate therapy after parathyroid hormone therapy led to significant increases in bone mineral density in comparison with the results for placebo after parathyroid hormone therapy, a difference particularly evident for bone mineral density in trabecular bone at the spine on quantitative CT (an increase of 31 percent in the parathyroid hormone–alendronate group as compared with 14 percent in the parathyroid hormone–placebo group). During year 2, subjects receiving placebo lost substantial bone mineral density.

Conclusions After one year of parathyroid hormone (1–84), densitometric gains appear to be maintained or increased with alendronate but lost if parathyroid hormone is not followed by an antiresorptive agent. These results have clinical implications for therapeutic choices after the discontinuation of parathyroid hormone.

Source Information

From the Departments of Epidemiology and Biostatistics (D.M.B., L.P., T.H.) and Radiology (T.F.L.), University of California, San Francisco; the Department of Medicine, College of Physicians and Surgeons, Columbia University, New York (J.P.B.); the Departments of Medicine and Epidemiology, Minneapolis Veterans Affairs Medical Center and University of Minnesota, Minneapolis (K.E.E.); the University of Pittsburgh Medical Center, Pittsburgh (S.L.G.); the National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Md. (J.A.M.); and the Maine Center for Osteoporosis Research, St. Joseph Hospital, Bangor (C.J.R.).

Address reprint requests to Dr. Black at the University of California, San Francisco, San Francisco Coordinating Center, 74 New Montgomery St., Suite 600, San Francisco, CA 94105, or at dblack{at}psg.ucsf.edu.

Full Text of this Article

Related Letters:

Alendronate and Parathyroid Hormone
Muldowney F. P., Black D. M., Sellmeyer D., Rosen C. J., Cosman F., Nieves J., Lindsay R.
Extract | Full Text | PDF  
N Engl J Med 2005; 353:2618-2619, Dec 15, 2005. Correspondence

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