Endocrine Abstracts

Introduction: Teriparatide is an osteoanabolic agent approved for the treatment of osteoporosis in postmenopausal women, in men with increased fracture risk, and in glucocorticoid-induced osteoporosis. The aim of this study was to evaluate the real-world use and efficacy of teriparatide.

Patients and Methods: We retrospectively assessed all patients with available data, who received teriparatide at Leeds Teaching Hospitals over 2004-2022. Patients who did not complete the 2-year treatment course were excluded. Data on bone turnover markers (P1NP/CTX), bone mineral density (BMD), treatment adherence and sequential therapy was analysed.

Results: 87 patients were identified. Three patients discontinued teriparatide early. Eight deaths were recorded. 76 patients (88% female; age at diagnosis 65.8±11.3 years) were included in the final analysis. 65 patients (86%) met NICE criteria for teriparatide treatment. Eight patients (11%) were treatment-naïve. Prior to teriparatide, 49% received oral bisphosphonates, 32% IV bisphosphonates, 8% denosumab and 1% HRT. There was no significant difference in the baseline BMD between the treatment-naïve and pre-treated patients. Post-teriparatide, mean BMD gain was 12% (0.085±0.15 g/cm²) at the spine and 4% (0.027±0.1 g/cm²) at the hip respectively. There was no significant difference between the pre-treatment and treatment-naïve groups. Amongst the pre-treated patients, a significant gain in BMD was observed at the spine, but not at hip. There were 13 non-responders, based on BMD and/or bone turnover markers. 9 patients sustained a fragility fracture during the treatment course. Sites being vertebral (5/9), hip (1/9) or other sites (3/9) There was no significant difference in the fracture rate between the responders and non-responders. 58 patients (76%) switched to antiresorptive therapy in the form of oral bisphosphonates (5%); zoledronate (26%); denosumab (46%).

Conclusions: Initiating Teriparatide was in line with NICE guidance. Our data demonstrated the positive BMD response at the lumbar spine in keeping with findings from the EUROFORS study