Endocrine Abstracts

Introduction: Known as a potent anabolic drug, teriparatide has a stimulating effect on bone formation, increasing bone mineral density (BMD) and reducing fracture risk.

Methods: 11 Caucasian women (mean age 66 years old) with severe osteoporosis treated with recombinant human parathyroid hormone (1–34) – teriparatide (Forsteo) 20 micrograms daily for 24 months were added to the study.

BMD at lumbar spine, total hip and femoral neck was measured before treatment (baseline), 12 and 24 months after initiation using dual energy x-ray absorptiometry (DXA GE Lunar). Two patients had plate osteosynthesis material at lumbar spine so DXA was performed only at total hip and femoral neck. All patients had fragility fractures, diagnosed with radiography/ vertebral MRI/ VFA: 3/11 had one vertebral fracture, 6/11 multiple vertebral fractures, 3/11 forearm fractures, 3/11 femoral fractures (one bilateral), 1/11 patella fracture and 1/11 had a pelvic fracture.

One patient had postpartum BMD below the expected range for age and vertebral fractures. 7/11 patients had previous anti–osteoporosis treatment. After 24 months of teriparatide, 10/11 patients started ibandronate 3 mg iv every 3 months, 1/11 started denosumab 60 mg sc every six months.

All received daily supplements of 500–1000 mg of calcium and 1000–2000 IU of Vitamin D. We measured osteocalcin (OC) at baseline, 12 and 24 months after initiation. We determined changes in percentage of BMD and serum OC in 12 and 24 months compared to baseline.

Results: Treatment with teriparatide determined an increase in BMD of total hip after 12 months (+ 2.18%) and significant increase after 24 months (+ 3.53%). The BMD changes at the femoral neck were 5.32% at 12 months and 3.15% after 24 months. The most significant increase in BMD was found at lumbar spine: 9.08% after 12 months and 8.36% after 24 months compared to baseline. The increase in OC was 90.47% after 12 months and 40.4 % after 24 months of teriparatide. The patient with postpartum BMD below expected for age had an important increase in BMD at lumbar spine after 12 months of 16.45% and of 24.1% after 24 months.

Treatment was well tolerated, and no serious side effects were observed.

No new fractures were diagnosed during treatment.

Conclusion: Our study suggests that teriparatide has an effective osteoanabolic effect and it is safe and well tolerated. Prolongation of follow–up is needed to see the evolution of BMD on patient treated with antiresorptive agents following teriparatide.