A review of data from large clinical trials reported more than 90% of subjects significantly improved their bone mineral density (BMD) at the lumbar spine (LS) with teriparatide (TPTD) (bone 39:1268–1275, 1). However, our clinical experience suggests that many patients may be non-responders, raising questions as to the true efficacy of TPTD in improving BMD in osteoporotic patients.
The purpose of the study is to determine the rate of improvement in BMD following 18–24 months of teriparatide (TPTD) in patients with osteoporosis within an orthopedic hospital setting.
This is a retrospective chart review of patients with osteoporosis who completed 18–24 months of TPTD therapy. The primary endpoint was the change in BMD at lumbar spine (LS) and hip-femoral neck (FN) and total hip (TH) following treatment. Secondary endpoints included the effect of prior bisphosphonate therapy, age, body mass index (BMI) and family history of fracture on BMD response, and the changes in bone-specific markers during active treatment.
Seventy-eight women and men with mean T-scores at the LS = −2.63 met the inclusion criteria. The overall group showed a 10.7% increase in LS-BMD after 24 months of TPTD. Eighty-three percent were considered responders defined as ≥3.0% increase in LS-BMD. Non-responders (16.7%) had mean LS-BMD change = −1.41%. No difference in baseline vitamin D, calcium, creatinine, BMI, age, gender, prior fracture history, or bisphosphonate use was observed between responders and non-responders. No consistent pattern of change in measures of bone markers was noted between responders and non-responders.
Eighty-three percent of patients with osteoporosis showed a >3% increase in BMD after TPTD treatment. Baseline parameters, prior bisphosphonate therapy, and the changes in bone markers showed no correlation with final BMD outcome.
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The authors thank Mr. Erik Nielsen for his assistance in collating the early patient data.
Conflict of Interest
So-Young Kim, MD, Meng Zhang, PhD, and Richard Bockman, MD, PhD, have declared that they have no conflict of interest.
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5).
Informed consent was waived from all patients for being included in the study.
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Work performed at Hospital for Special Surgery.
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Kim, S., Zhang, M. & Bockman, R. Bone Mineral Density Response from Teriparatide in Patients with Osteoporosis. HSS Jrnl 13, 171–177 (2017). https://doi.org/10.1007/s11420-016-9537-1
- teriparatide treatment
- clinical outcome
- bone markers