Endocrine Abstracts

Backgroud: When considering treatment of patients with severe osteoporosis (after previously failed antiresorptive treatment) or patients with glucocorticoid–induced osteoporosis, it is suitable to choose treatment by teriparatide (TPTD, rhPTH 1–34). In contrast to long–term treatment by bisphosphonates (BP) or denosumab (DMAB), the treatment with TPTD increases the volume of trabecular bone and the thickness of cortical bone. The recommended length of treatment is 24 months necessarily followed by an antiresorptive treatment in order to prevent loss of newly gained bone mass.

Methods: The study sample included women with severe postmenopausal osteoporosis (PMO, n = 14) and patients with glucocorticoid-induced osteoporosis (GIO, n = 37) who finished two-year TPTD treatment. At baseline visit (after discontinuation of TPTD treatment) were measured BMD of lumbar spine, hip and distal forearm and biochemical markers of bone turnover (serum intact amino-terminal propeptide of type I procollagen, type 1 collagen cross-linked C-telopeptide). A follow-up visit was performed anually during treatment by DMAB (Prolia 60 mg s.c. once per 6 months) or treatment by risedronate (Risendros tablets 35 mg/weekly). All patients received vitamin D substitution (cholecalciferol 1000–4000 IU/daily) and calcium (500–1000 mg/daily).

Results: Patients with PMO treated with TPTD for 2 years followed by 4 years of DMAB treatment (n = 14) increased lumbar spine BMD +19.5% and total femur BMD + 6.2% during the 6–year study period. Patients with GIO treated by DMAB (n = 10) increased lumbar spine BMD + 11.7% and total femur BMD + 4.5% in the same period. The group of patients with GIO treated by risedronate (n = 27) gained 9.7% in the lumbar spine BMD and 2.5% in total femur BMD during this period. The TPTD treatment invoked comparable increase in lumbar spine BMD and total femur BMD in both PMO and GIO patients in the first two years of the study. The following 4 years of DMAB treatment induced notably higher increase in lumbar spine BMD and total femur BMD in PMO patients compared to GIO patients. Treatment with risedronate resulted in a comparable increase in lumbar spine BMD in GIO patients, but a decrease in total femur BMD after the first year of treatment was detected.

Conclusion: Results from non-selective group of patients from ordinary clinical practice demonstrated that the response to treatment is significantly influenced by other risk factors (e.g. treatment of glucocorticoids, immobility, etc.) For patients with a very high risk of fragility fracture, the sequential treatment with TPTD should be the primary osteoporosis treatment choice.