The use of teriparatide in the treatment of postmenopausal osteoporosis: experience of using bone markers and bone mineral density to monitor response

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Introduction: Teriparatide (1-34 N-terminal active fragment of parathyroid hormone) is recommended for women with severe osteoporosis and high risk of fracture who have failed/are intolerant of first line therapy.1 This audit assessed
prescribing of teriparatide as per NICE guidelines
lumbar spine (LS) and total hip bone mineral density (BMD) response following 18 months teriparatide and correlation with bone turnover marker (BTM) response
fracture outcome post therapy.
Methods: All patients commencing teriparatide from October 2004 until August 2010 were identified. DEXA scanning was performed on a GE Lunar Prodigy scanner. Procollagen type 1 N-propeptide (P1NP) and C-terminal telopeptides of type 1 collagen (CTX) were measured using the Elecsys 2010 auto-analyser (Roche, USA).
Results: Eighty-two patients (mean age 73.1 ± 7.1 years; prevalent vertebral fractures 2.7 ± 2.0) were identified; 41/82 patients did not fulfil BMD criteria for prescription of teriparatide; 77/82 patients completed 18 months treatment. Median % change BMD LS and hip (n = 76) was 8.7 (–7 to 32.1) and 0.0 (–17.7 to 15.9), respectively. Median % change P1NP and CTX at 6 months (n = 62) was 249.5 (–28 to 1685) and 158 (–58 to 1512), respectively. No significant correlation was observed between BTM response and % change LS BMD. Of 77 patients, 73 have had no further fractures since starting therapy (median time to non-fracture 4 years).
Deviations from BMD criteria reflected artificial elevation of T-scores. Most patients had >3% increase LS BMD with little change in hip BMD. Magnitude of BTM response did not predict LS BMD response, however, Teriparatide appears effective in reducing vertebral and non-vertebral fractures irrespective of BMD/BTM response.
Original languageEnglish
Pages (from-to)E33-E34
Number of pages2
JournalScottish Medical Journal
Issue number4
Publication statusPublished - Nov 2013

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