Bone Abstracts

Introduction: Evidence in literature shows how is useful to use antiresorptive drugs such as bisphosphonates, in severe osteoporosi severe after PTH (1–34 or 1–84) treatment.

Methods: This study was divided into two parts: the first one analyzed BMD changes by DXA at the lumbar and femoral and serum osteocalcin and β-CTX, monitoring their performance after 6, 12 and 18 months in 71 women with severe postmenopausal osteoporosis, treated for 18 months with PTH 1–84.

In the second phase of the study, 66.66% (50 of 71 treated patients) was divided into five groups (each with ten patients), who received Calcium (1 g/day) and vitamin D (5600 IU/week). Patients, respectively, taking alendronate, risedronate weekly, ibandronate monthly and strontium ranelate dayly and in the last group only vitamin D and Calcium. After 18 months was evaluated again BMD at the spine and femur.

Results: We observed a slight increase in femoral T-score at the end of treatment, (P=0.07, Wilcoxon test), more significant at the lumbar spine (baseline =−3.3±0.9 and −2.7±1.2 at the end of treatment (P<0.001, Wilcoxon test). Osteocalcin was increased (ANOVA, P<0.001), 4.4 times from baseline at 6th month, 5.4 and 3.1, respectively, at 12th and 18th months (Bonferroni, P<0.001). β-CTX levels showed an increase of 2.5 times from baseline at month 6th, 2.6 and 1, 8 respectively at 12th and 18th months (P<0.001). After 18 months of therapy with other bisphosphonates, strontium ranelate and calcium and vitamin D further significant increases were evidenced in T-scores after ibandronate (+0.9, 95% CI: +0.2,+1.5, P <0.05), ranelate (+0.8, 95% CI: +0.4,+1.3, P <0.05), risendronate (+1.6, 95% CI: +1.0,+2.3, P <0.05).

Conclusions: These results suggest that in severe osteoporosis the treatment of choice would include a first cycle of 18 months with PTH 1–84, followed by subsequent therapy with antiresorptive drugs or ranelate strontium.