Aasis Unnanuntana MD, Quang V. Ton MD, John P. Kleimeyer BA, Joseph T. Nguyen MPH, Joseph M. Lane MD
A Fracture Does Not Adversely Affect Bone Mineral Density Responses after Teriparatide Treatment
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 datafrom 141 patients treated with teriparatide for osteoporosis. Seventy-seven patients received teriparatide after fractures (fracture group),whereas 64were treated for other indications (nonfracture group).We determined BMDat 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.
COMMENTO
L’obiettivo degli autori è valutare l’efficacia del teriparatide nei pazienti con fratture da fragilità e nei pazienti osteoporotici non fratturati;la frattura è un evento traumatico che induce alterazioni metaboliche sia a livello locale (fracture healing) che sistemico(systemic catabolic state).Il teriparatide è in grado di modificare i valori di BMD e dei markers osteometabolici in entrambi i casi in maniera analoga. La frattura incidente, in corso di trattamento, pertanto non modifica l’efficacia del teriparatide.