Treatment with zoledronate or teriparatide for a year did not affect intima-media thickness of the carotid arteries in postmenopausal women with osteoporosis, according to study results published in the International Journal of Immunopathology & Pharmacology.

Previous reports have associated osteoprotegerin and osteopontin, 2 major markers of bone metabolism, with vascular calcification and atherosclerosis. In this prospective observational pilot study, researchers studied the effects of 12 months of treatment with zoledronate or teriparatide on carotid intima-media thickness, a well-established marker of atherosclerosis, as well as on biochemical markers of bone metabolism.

The study cohort included 20 postmenopausal women with osteoporosis, including 11 patients treated with zoledronate (mean age, 73 years) and 9 patients treated with teriparatide (mean age, 70 years). In addition, a control group included 10 postmenopausal women matched for age, body mass index, and glucose and lipid levels who did not receive treatment for osteoporosis or statin therapy.

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Baseline values of carotid intima-media thickness were similar in all participants and increased after 12 months in all 3 groups. The increase in carotid intima-media thickness was not significant in women treated with zoledronate or in the control group; in women treated with teriparatide, the increase in thickness was statistically significant (1.0 mm [95% CI, 0.8-1.2] vs 1.1 mm [95% CI, 0.9-1.5]; P =.04), but clinically, the change was minimal (0.1 mm).

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In the group receiving teriparatide, there was a positive correlation between carotid intima-media thickness and alkaline phosphatase level (r, 0.767; P =.008) and a negative correlation with levels of high-density lipoprotein cholesterol (r, -0.65; P =.03). These findings may point to a synergy between bone remodeling and an adverse lipid profile. However, these correlations were not found in women treated with zoledronate. There was no correlation between carotid intima-media thickness and bone metabolism markers.

The small sample size was the major limitation of this study, according to the researchers, and a larger extension study is needed.

“[Zoledronate] and [teriparatide] treatment are safe on carotid walls in [women with osteoporosis] with subclinical atherosclerosis,” concluded the investigators.

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Passeri E, Mazzaccaro D, Sansoni V, et al. Effects of 12-months treatment with zoledronate or teriparatide on intima-media thickness of carotid artery in women with postmenopausal osteoporosis: a pilot study. Int J Immunopathol Pharmacol. 2019;33:1-7.