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JRPMS Vol 4, No 1, March 2020, p.8-14

doi: 10.22540/JRPMS-04-008


Οriginal Article

Coadministration of zoledronic acid and teriparatide in postmenopausal osteoporosis

Christiana Zidrou, Anastasios Beletsiotis

  • 2nd Orthopaedic Department, G. Papageorgiou General Hospital, Thessaloniki, Greece

Keywords: Bisphosphonates, Bone mineral density, Osteoporosis, Teriparatide, Zoledronic acid


Objectives: The purpose of this study is to evaluate the effects of combination therapy with an intravenous infusion of zoledronic acid 5 mg and daily subcutaneous teriparatide 20 μg versus either agent alone on bone mineral density (BMD) and bone turnover markers. Methods: From January 2015 to December 2018, 206 postmenopausal women with osteoporosis (aged 55-89 years) were randomized to receive a single infusion of zoledronic acid 5 mg plus daily subcutaneous teriparatide 20 μg (n = 68), zoledronic acid alone (n=69), or teriparatide alone (n=69). The primary endpoint was percentage increase in lumbar spine and total hip BMD (assessed by DXA) at 52 weeks versus baseline. Results: At week 52, lumbar spine BMD had increased 7.5%, 7.0%, and 4.4% in the combination, teriparatide, and zoledronic acid groups, respectively while total hip -BMD increments were 2,3%, 1,1% and 2,2% in respective subgroups. Levels for bone turnover markers (PINP and b-CTX) were significantly lower with combination therapy versus teriparatide alone. Conclusions: The authors concluded that while teriparatide increases spine BMD more than zoledronic acid and zoledronic acid increases hip BMD more than teriparatide, combination therapy provides the largest, most rapid increments when both spine and hip sites are considered.