Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Algorithm for Using a Bone Formation Marker PINP To Monitor the Response to Teriparatide (TPTD) in Patients with Glucocorticoid-Induced Osteoporosis (GIO).

Lane2,  Nancy E., See1,  Kyoungah, Warner1,  Margaret, Krege1,  John H.

Eli Lilly, Indianapolis, IN
Univ of California at Davis, Hillsborough, CA

Biochemical markers of bone turnover may provide useful information about response to a treatment. A least-significant change algorithm using the serum concentration of N-terminal type I procollagen propeptide (PINP), has been proposed to aid in the management of patients with postmenopausal osteoporosis treated with TPTD (Eastell et al. Curr Med Res Opin 2006;22:61-6). The purpose of this post-hoc analysis was to assess this approach in GIO patients treated with teriparatide (TPTD). Patients who took at least 5 mg of prednisone or equivalent for at least 3 months were treated for up to 36 months with TPTD 20 g/day. Patients with a baseline and postbaseline (1 and 6 months) PINP were included in this analysis. Responders were defined as patients with an increase in PINP of >10 g/L (least significant change) at 1 or 6 months. At 1 month, the signal-to-noise ratio for PINP was 3.0 compared with 1.2 for bone-specific alkaline phosphatase (bone ALP), 1.4 for C-terminal telopeptide of type I collagen (CTX), 3.2 for osteocalcin (OC), and 2.0 for C-terminal type I procollagen propeptide (PICP). Of the TPTD-treated patients, 88% were responders. PINP responders had significantly greater increases in bone ALP, PICP, and OC (p<0.03) at 1 month, compared with nonresponders. In summary, PINP responders had greater than two-fold larger mean percentage increases from baseline in lumbar spine (LS) bone mineral density (BMD) at 12, 24, and 36 months versus non-responders. In patients with GIO, PINP had a high signal-to-noise ratio and most patients treated with teriparatide had a significant increase in PINP. Patients who had a significant increase in PINP had a significantly greater increase in BMD than the small number of patients who did not have a significant increase in PINP. The PINP findings in patients with GIO treated with TPTD in this study were similar to previously reported results in postmenopausal women with osteoporosis.

Lumber Spine BMD gain [mean ± SE (n)]**

PINP12 months24 months36 months
> 10ug/L8.2%± 0.73 (n = 70)11.4%± 1.00 (n = 60)13.3%± 1.21 (n = 55)
< 10 ug/L3.6%± 1.13 (n = 10)5.1%± 1.37 (n = 9)4.6%± 3.19 (n = 7)
p-value*0.0230.0210.018
*Responders vs non-responders based on Wilcoxon rank-sum test
**Values are mean percentage change from baseline in LS BMD
SE= standard error.

To cite this abstract, please use the following information:
Lane, Nancy E., See, Kyoungah, Warner, Margaret, Krege, John H.; Algorithm for Using a Bone Formation Marker PINP To Monitor the Response to Teriparatide (TPTD) in Patients with Glucocorticoid-Induced Osteoporosis (GIO). [abstract]. Arthritis Rheum 2010;62 Suppl 10 :957
DOI: 10.1002/art.28724

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