• Joel S Finkelstein, Jason J Wyland, Hang Lee, and Robert M Neer.
• Department of Medicine, Endocrine Unit, Massachusetts General Hospital, Boston, Massachusetts 02114, USA. jfinkelstein@partners.org
• J. Clin. Endocrinol. Metab. 2010 Apr 1;95(4):1838-45.

ContextTeriparatide increases both bone formation and bone resorption.ObjectiveWe sought to determine whether combining teriparatide with an antiresorptive agent would alter its anabolic action.Design And SettingThis was a randomized controlled trial conducted in a single university hospital.Patients And InterventionWe randomized 93 postmenopausal women with low bone mineral density (BMD) to alendronate 10 mg daily (group 1), teriparatide 40 microg sc daily (group 2), or both (group 3) for 30 months. Teriparatide was begun at month 6.Main Outcome MeasuresBMD of the lumbar spine, proximal femur, proximal radius, and total body was measured by dual-energy x-ray absorptiometry (DXA) every 6 months. Lumbar spine trabecular BMD was measured at baseline and month 30 by quantitative computed tomography. Serum osteocalcin, N-terminal propeptide of type 1 collagen, and N-telopeptide levels were assessed frequently. Women who had at least one repeat DXA scan on therapy were included in the analyses (n = 69).ResultsDXA spine BMD increased more in women treated with teriparatide alone than with alendronate alone (18 +/- 11 vs. 7 +/- 4%; P < 0.001) or both (18+/-11 vs. 12 +/- 9%; P = 0.045). Similarly, femoral neck BMD increased more in women treated with teriparatide alone than with alendronate alone (11 +/- 5 vs. 4 +/- 4%; P < 0.001) or both (11 +/- 5 vs. 3 +/- 5%; P < 0.001). Quantitative computed tomography spine BMD increased 1 +/- 7, 61 +/- 31, and 24 +/- 24% in groups 1, 2, and 3 (P < 0.001 for all comparisons). Serum osteocalcin, N-terminal propeptide of type 1 collagen, and cross-linked N-telopeptides of type I collagen increased more with teriparatide alone than with both (P < 0.001 for each marker).ConclusionAlendronate reduces the ability of teriparatide to increase BMD and bone turnover in women.

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