This means I am correct a .. gain.
Phosphate versus a bisphosphonate and phosphate wins.
That means my freeee bisphosphonate .. a .. gain ..

Phosphate and Alendronate Helpful in Adult Growth Hormone Deficiency

NEW YORK (Reuters Health) Feb 07 - Phosphate or alendronate given in
combination with standard growth hormone replacement (GHR) leads to a
greater improvement in bone mineral density (BMD) in adults with
growth hormone deficiency, UK researchers report in a January 20th
online paper in the Journal of Clinical Endocrinology & Metabolism.

Dr. H. D. White and colleagues at the University of Liverpool note
that the condition is associated with osteoporosis, and occurs as the
result of reduced sensitivity of the bone and kidney to the effect of
PTH. Overall prevalence is reportedly between 2 and 3 per 10,000.

The researchers note that GHR and alendronate is a first-line
osteoporosis treatment at their center. Standard practice in the UK is
to offer GHR to all patients with severe GH deficiency. Serum
phosphate is a regulator of PTH secretion and also may be of value.

To examine these alternatives, the researchers studied 44 patients.
Those who were previously naive to GH were randomized to receive GH
replacement alone or with alendronate or phosphate. Patients already
receiving GHR continued with that treatment alone or in combination
with alendronate or phosphate.

After a year, patients receiving phosphate had significantly greater
increases in nephrogenous cAMP (a marker of renal PTH activity) than
those on GH alone. There was also a significantly greater increase in

BMD was also significantly improved but to a lesser extent in the
alendronate combination group. Type-I collagen beta C-telopeptide (a
marker of bone resorption) also decreased to a greater extent in this
group than in those receiving GH alone.

"Phosphate appears to exert its effect by increasing PTH target-organ
action, whereas alendronate acts primarily through reduction in bone
resorption," say the investigators.

They add that the condition may serve as a model for age-related
osteoporosis but further investigation into the use of phosphate
therapy in primary osteoporosis is necessary.

J Clin Endocrinol Metab. Posted online January 20, 2010. Abstract

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