Effects of PTH and Alendronate on Type I Collagen Isomerization in Postmenopausal Women With Osteoporosis: The PaTH Study

Fracture efficacy of PTH and alendronate (ALN) is only partly explained by changes in BMD, and bone collagen properties have been suggested to play a role. We analyzed the effects of PTH(1–84) and ALN on urinary αα/ββ CTX ratio, a marker of type I collagen isomerization and maturation in postmenopau...

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Published in:Journal of bone and mineral research 2008-09, Vol.23 (9), p.1442-1448
Main Authors: Garnero, Patrick, Bauer, Doug C, Mareau, Emmanuel, Bilezikian, John P, Greenspan, Susan L, Rosen, Clifford, Black, Dennis
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
alendronate
Alendronate - pharmacology
Alendronate - therapeutic use
biochemical markers
Biological and medical sciences
Biomarkers - metabolism
Bone and Bones - drug effects
Bone and Bones - metabolism
Collagen Type I - chemistry
Collagen Type I - urine
Female
Fundamental and applied biological sciences. Psychology
Humans
Isomerism
Middle Aged
Original
osteoporosis
Osteoporosis, Postmenopausal - drug therapy
Osteoporosis, Postmenopausal - urine
Parathyroid Hormone - pharmacology
Parathyroid Hormone - therapeutic use
Placebos
PTH
Skeleton and joints
type I collagen
Vertebrates: osteoarticular system, musculoskeletal system
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Summary:Fracture efficacy of PTH and alendronate (ALN) is only partly explained by changes in BMD, and bone collagen properties have been suggested to play a role. We analyzed the effects of PTH(1–84) and ALN on urinary αα/ββ CTX ratio, a marker of type I collagen isomerization and maturation in postmenopausal women with osteoporosis. In the first year of the previously published PaTH study, postmenopausal women with osteoporosis were assigned to PTH(1–84) (100 μg/d; n = 119), ALN (10 mg/d; n = 60), or PTH and ALN together (n = 59). We analyzed patients on ALN alone (n = 60) and a similar number of patients assigned to PTH alone (n = 63). During the second year, women on PTH in the first year were reallocated to placebo (n = 31) or ALN (n = 32) and women with ALN continued on ALN. During the first year, there was no significant change in αα/ββ CTX ratio with PTH or ALN. At 24 mo, there was a marked increase of the αα/ββ CTX ratio in women who had received PTH during the first year, followed by a second year of placebo (median: +45.5, p < 0.001) or ALN (+55.2%, p < 0.001). Conversely, the αα/ββ CTX ratio only slightly increased (+16%, p < 0.05) after 2 yr of continued ALN. In conclusion, treatment with PTH(1–84) for 1 yr followed by 1 yr of placebo or ALN may be associated with decreased type I collagen isomerization. The influence of these biochemical changes of type I collagen on bone fracture resistance remains to be studied.
ISSN:0884-0431
1523-4681
DOI:10.1359/jbmr.080413