Clinical Orthopaedics and Related Research®

, Volume 470, Issue 3, pp 927–936

A Fracture Does Not Adversely Affect Bone Mineral Density Responses after Teriparatide Treatment

  • Aasis Unnanuntana
  • Quang V. Ton
  • John P. Kleimeyer
  • Joseph T. Nguyen
  • Joseph M. Lane
Clinical Research

DOI: 10.1007/s11999-011-2029-1

Cite this article as:
Unnanuntana, A., Ton, Q.V., Kleimeyer, J.P. et al. Clin Orthop Relat Res (2012) 470: 927. doi:10.1007/s11999-011-2029-1



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.


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 data from 141 patients treated with teriparatide for osteoporosis. Seventy-seven patients received teriparatide after fractures (fracture group), whereas 64 were treated for other indications (nonfracture group). We determined BMD at 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.


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.


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.

Level of Evidence

Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Copyright information

© The Association of Bone and Joint Surgeons® 2011

Authors and Affiliations

  • Aasis Unnanuntana
    • 1
    • 2
  • Quang V. Ton
    • 3
  • John P. Kleimeyer
    • 4
  • Joseph T. Nguyen
    • 5
  • Joseph M. Lane
    • 1
  1. 1.Department of Orthopaedic SurgeryHospital for Special SurgeryNew YorkUSA
  2. 2.Department of Orthopaedic SurgerySiriraj Hospital, Mahidol UniversityBangkokThailand
  3. 3.Department of Internal MedicineEnglewood Hospital and Medical CenterNew YorkUSA
  4. 4.Weill Cornell Medical CollegeCornell UniversityNew YorkUSA
  5. 5.Department of Epidemiology and Biostatistics CoreHospital for Special SurgeryNew YorkUSA

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