CONCLUSION Estrogen with an osteoblast P4R-acting progestin ( EPT ) in these five published RCT provides Level 1 evidence that MPA caused significantly greater annual percent spinal BMD gains than the same dose of ET .
OBJECTIVE To assess whether progesterone ( P4 ) or osteoblast P4 receptor-acting progestin ( P ) contributed to estrogen ( E ) therapy-related  increased areal bone mineral density ( BMD ) in r and omized controlled trials ( RCT ) with direct r and omization to estrogen ( ET ) or estrogen-progestin ( EPT ) therapy .
A randomized double-blind trial to compare the efficacy of teriparatide [recombinant human parathyroid hormone (1-34)] with alendronate in postmenopausal women with osteoporosis.
Teriparatide ( rDNA origin ) injection [ recombinant human PTH ( 1 - 34 ) ] stimulates bone formation , increases bone mineral density ( BMD ) , and restores bone architecture and integrity . In contrast , bisphosphonates reduce bone resorption and increase BMD . We compared the effects of teriparatide and alendronate sodium on BMD , nonvertebral fracture incidence , and bone turnover in 146 postmenopausal women with osteoporosis . Women were r and omized to either once-daily sc injections of teriparatide 40 micro g plus oral placebo ( n = 73 ) or oral alendronate 10 mg plus placebo injection ( n = 73 ) . Median duration of treatment was 14 months . At 3 months , teriparatide increased lumbar spine BMD significantly more than did alendronate ( P < 0.001 ) . Lumbar spine-BMD increased by 12.2 % in the teriparatide group and 5.6 % in the alendronate group ( P < 0.001 teriparatide vs. alendronate ) . Teriparatide increased femoral neck BMD and total body bone mineral significantly more than did alendronate , but BMD at the one third distal radius decreased , compared with alendronate ( P < or = 0.05 ) . Nonvertebral fracture incidence was significantly lower in the teriparatide group than in the alendronate group ( P < 0.05 ) . Both treatments were well tolerated despite transient mild asymptomatic hypercalcemia with teriparatide treatment . In conclusion , teriparatide , a bone formation agent , increased BMD at most sites and decreased nonvertebral fractures more than alendronate
CONCLUSION Estrogen with an osteoblast P4R-acting progestin ( EPT ) in these five published RCT provides Level 1 evidence that MPA caused significantly greater annual percent spinal BMD gains than the same dose of ET .
OBJECTIVE To assess whether progesterone ( P4 ) or osteoblast P4 receptor-acting progestin ( P ) contributed to estrogen ( E ) therapy-related  increased areal bone mineral density ( BMD ) in r and omized controlled trials ( RCT ) with direct r and omization to estrogen ( ET ) or estrogen-progestin ( EPT ) therapy .