BACKGROUND: Fracture leads to local and systemic catabolic physiologic changes. As teriparatide is an agent used to treat osteoporosis in patients with fragility fractures, it is unclear whether teriparatide treatment alters bone mineral density (BMD) and bone markers when given to patients with fractures. QUESTIONS/PURPOSES: We asked whether BMD and bone marker responses would be blunted in patients with fractures placed on teriparatide after fracture compared with patients without fractures on teriparatide. PATIENTS AND METHODS: We retrospectively collected data from 141 patients treated with teriparatide for osteoporosis. Seventy-seven patients received teriparatide after fractures (fracture group), whereas 64 were treated for other indications (nonfracture group). We determined BMD at the lumbar spine and at the proximal femur before and 12 and 24 months posttreatment. Bone markers (urine N-telopeptide [urine NTX], bone-specific alkaline phosphatase [BALP]) were measured at baseline and 3, 12, and 24 months posttreatment. RESULTS: Mean lumbar spine and hip BMDs at last followup increased from baseline with no differences between groups to approximately 9% and 4% at 24 months, respectively. Both bone markers increased from baseline in the nonfracture group, peaking at 12 months. For the fracture group, only urine NTX increased at 3 and 12 months posttreatment. Although the peak levels of both bone markers in the nonfracture group were greater, there was no difference between the two groups. CONCLUSIONS: Fracture does not have a negative effect on the BMD and bone marker responses to teriparatide treatment. Clinicians should anticipate comparable BMD responses when treating patients with teriparatide for osteoporotic fractures and for other indications. LEVEL OF EVIDENCE: Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
BACKGROUND:Fracture leads to local and systemic catabolic physiologic changes. As teriparatide is an agent used to treat osteoporosis in patients with fragility fractures, it is unclear whether teriparatide treatment alters bone mineral density (BMD) and bone markers when given to patients with fractures. QUESTIONS/PURPOSES: We asked whether BMD and bone marker responses would be blunted in patients with fractures placed on teriparatide after fracture compared with patients without fractures on teriparatide. PATIENTS AND METHODS: We retrospectively collected data from 141 patients treated with teriparatide for osteoporosis. Seventy-seven patients received teriparatide after fractures (fracture group), whereas 64 were treated for other indications (nonfracture group). We determined BMD at the lumbar spine and at the proximal femur before and 12 and 24 months posttreatment. Bone markers (urine N-telopeptide [urine NTX], bone-specific alkaline phosphatase [BALP]) were measured at baseline and 3, 12, and 24 months posttreatment. RESULTS: Mean lumbar spine and hip BMDs at last followup increased from baseline with no differences between groups to approximately 9% and 4% at 24 months, respectively. Both bone markers increased from baseline in the nonfracture group, peaking at 12 months. For the fracture group, only urine NTX increased at 3 and 12 months posttreatment. Although the peak levels of both bone markers in the nonfracture group were greater, there was no difference between the two groups. CONCLUSIONS:Fracture does not have a negative effect on the BMD and bone marker responses to teriparatide treatment. Clinicians should anticipate comparable BMD responses when treating patients with teriparatide for osteoporotic fractures and for other indications. LEVEL OF EVIDENCE: Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Authors: Richard Eastell; Thomas Nickelsen; Fernando Marin; Clare Barker; Peyman Hadji; Jordi Farrerons; Maurice Audran; Steven Boonen; Kim Brixen; Jose Melo Gomes; Barbara Obermayer-Pietsch; Avraam Avramidis; Gunnar Sigurdsson; Claus C Glüer Journal: J Bone Miner Res Date: 2009-04 Impact factor: 6.741
Authors: K M Nelson; E W Richards; C L Long; K R Martin; J W Geiger; S W Brooks; R E Gandy; W S Blakemore Journal: Metabolism Date: 1995-01 Impact factor: 8.694
Authors: Barbara M Obermayer-Pietsch; Fernando Marin; Eugene V McCloskey; Peyman Hadji; Jordi Farrerons; Steven Boonen; Maurice Audran; Clare Barker; Athanasios D Anastasilakis; William D Fraser; Thomas Nickelsen Journal: J Bone Miner Res Date: 2008-10 Impact factor: 6.741
Authors: Felicia Cosman; Robert A Wermers; Christopher Recknor; Karen F Mauck; Li Xie; Emmett V Glass; John H Krege Journal: J Clin Endocrinol Metab Date: 2009-07-07 Impact factor: 5.958