Statins Do Not Affect Bone Anabolism in Older Women Treated With Teriparatide

Teriparatide [rhPTH (1-34)] is an established anabolic agent for the treatment of severe osteoporosis. Statins, 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors, have demonstrated antiresorptive properties, but their impact on the anabolic efficacy of rhPTH remains unclear.

To evaluate whether concurrent statin therapy influences changes in bone mineral density (BMD) and bone turnover markers in women receiving rhPTH.

This retrospective cohort study included 104 postmenopausal women with severe osteoporosis who completed 24 months of daily rhPTH (20 mcg subcutaneously) and biweekly cholecalciferol (25 000 IU). Patients were stratified by statin use. BMD at the lumbar spine and femoral neck was assessed at baseline and study completion. Bone turnover markers-alkaline phosphatase, osteocalcin, and C-terminal telopeptide of type I collagen-were measured every 6 months.

Thirty patients were statin users and 74 were nonusers. Statin users experienced lumbar spine BMD gain from 0.71 ± 0.16 to 0.79 ± 0.14 g/cm² (P = .01) and a trend toward femoral neck improvement from 0.53 ± 0.24 to 0.62 ± 0.12 g/cm² (P = .07). Nonusers also showed a lumbar spine BMD rise from 0.70 ± 0.10 to 0.77 ± 0.11 g/cm² (P = .001), with no significant femoral neck BMD change from 0.60 ± 0.11 to 0.58 ± 0.15 g/cm² (P = .5). At the end of the observation period, C-terminal telopeptide of type I collagen levels were significantly lower in statin users compared to nonusers (0.37 ± 0.29 vs 0.66 ± 0.47 ng/mL, P = .007). Conversely, no significant intergroup differences were observed for alkaline phosphatase and osteocalcin throughout the observation period.

Statin use does not impair the anabolic efficacy of rhPTH in increasing BMD in postmenopausal women with severe osteoporosis, but it provides additional antiresorptive benefits during rhPTH therapy. These findings support the continued use of statins and highlight the need for further prospective studies exploring synergistic effects.