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Bone Density After Teriparatide Discontinuation With or Without Antiresorptive Therapy in Pregnancy- and Lactation-Associated Osteoporosis

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Abstract

Pregnancy- and lactation-associated osteoporosis (PLO) is a rare and severe disorder that causes low-trauma or spontaneous fractures, most commonly multiple vertebral fractures, in the late pregnancy or lactation period [1]. In severe PLO, teriparatide (TPTD) might aid in bone mineral density (BMD) recovery and subsequent fracture risk reduction. However, it is unclear whether TPTD can be discontinued without sequential antiresorptive therapy (ART) in premenopausal women with PLO. In this retrospective cohort study, we investigated the changes in BMD in premenopausal women with PLO treated with TPTD 20 mcg daily with or without sequential ART. Data for 67 patients diagnosed with PLO from 2007 through 2017 were reviewed. Among 43 women with annual follow-up dual-energy X-ray absorptiometry data for 3 years, 33 were treated with TPTD (median 12 months) with (TPTD-ART, n = 13; median, 18 months) or without (TPTD-no ART, n = 20) sequential ART. The two groups showed no differences in the mean age (31 vs. 31 years), body mass index (BMI, 20.5 vs. 21.0 kg/m2), and baseline lumbar spine (LS) BMD (0.666 vs. 0.707 g/cm2; p > 0.05 for all). LSBMD increased at 1, 2, and 3 years from baseline in both the TPTD-ART (14.1%, 21.8%, and 24.0%, respectively) and TPTD-no ART (17.3%, 24.1%, and 23.4%, respectively) groups, without significant between-group differences. Similar results were observed for the total hip BMD. LSBMD gain at 3 years did not differ by ART use (adjusted β, 0.40; p = 0.874) in univariable and multivariable models adjusted for age, BMI, and baseline LSBMD. In summary, BMD gain by TPTD administration in premenopausal women with PLO can be well maintained without sequential ART treatment.

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Data Availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Acknowledgements

This work was supported by the ‘SENTINEL (Severance ENdocrinology daTa scIeNcE pLatform)’ program of the Endocrinology Division, Department of Internal medicine, Yonsei University College of Medicine, Seoul, Korea (4-2018-1215; DUCD000002).

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  1. Seunghyun Lee and Namki Hong have contributed equally.

Authors and Affiliations

  1. Department of Internal Medicine, Severance Hospital, Endocrine Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea

    Seunghyun Lee, Namki Hong, Kyoung Jin Kim, Chung Hyun Park, Jooyeon Lee & Yumie Rhee

  2. Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea

    Kyoung Jin Kim

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Correspondence to Yumie Rhee.

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Y. Rhee has served as a consultant for Amgen and has received honorarium from Amgen. Seunghyun Lee, Namki Hong, Kyoung Jin Kim, Chung Hyun Park, and Jooyeon Lee have no relevant disclosures.

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Lee, S., Hong, N., Kim, K.J. et al. Bone Density After Teriparatide Discontinuation With or Without Antiresorptive Therapy in Pregnancy- and Lactation-Associated Osteoporosis. Calcif Tissue Int 109, 544–553 (2021). https://doi.org/10.1007/s00223-021-00869-6

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