Comparison of alendronate and intranasal calcitonin for treatment of osteoporosis in postmenopausal women

This study compared the effects of oral alendronate and intranasal calciton in for treatment of osteoporosis in postmenopausal women. Women at least 5 yr postmenopause (n = 299) were randomized to either 10 mg alendronate, mat ching alendronate placebo, or open-label intranasal calcitonin 200 IU daily for 12 months. Rip and spine bone mineral density (BMD) and markers of bon e turnover were measured, and safety and tolerability were assessed. Alendr onate produced greater increases in BMD than calcitonin at 12 months at the lumbar spine (5.16% vs. 1.18%; P < 0.001), trochanter (4.73% vs. 0.47%; P < 0.001), and femoral neck (2.78% vs. 0.58%; P < 0.001). Changes in BMD wit h calcitonin were greater than with placebo at the femoral neck, but were n ot different from placebo at either the trochanter or lumbar spine. Greater decreases in bone turnover were seen with alendronate than with calcitonin (serum bone-specific alkaline phosphatase, 43% us. 9%, P < 0.001; urinary N-telopeptide, 62% us. 11%, P < 0.001). Similar percentages of patients in each group reported an adverse experience during the study. We conclude tha t, in postmenopausal women with osteoporosis, 12 months of therapy with ale ndronate produced significantly greater increases in BMD of the hip and spi ne and greater decreases in bone turnover than intranasal calcitonin.