Early efficacy of teriparatide in multilevel osteoporotic vertebral compression fractures treated by percutaneous vertebroplasty

Aims: Teriparatide [rhPTH(1–34)] has been shown to increase
bone mineral density (BMD) and reduce the risk of fracture in
postmenopausal women with osteoporosis. The purpose of this
study was to investigate the skeletal effects of 9 months of
treatment with teriparatide in women with osteoporotic vertebral
compression fractures treated previously by percutaneous vertebroplasty
and antiresorptive therapy for at least two years.
Methods: Daily subcutaneous injections of 20 μg teriparatide
were administered for 9 months to 30 postmenopausal women
previously submitted to percutaneous vertebroplasty for multilevel
vertebral compression fractures. Mean age was 71.3 years (range
59–83). All patients had previously received alendronate therapy
administered 70 mg/once weekly for 24–36 months. Before teriparatide
therapy the median baseline BMD T-score was%-2.5 and
the median baseline bone turnover markers levels were 24 μg of
osteocalcin, 87 μg of N-propeptide of type I pro-collagen, 15 μg of
bone-specific alkaline phosphatase and 13 nMolBCE/L of
N-telopeptide of collagen. All patients received daily calcium (1000
mg) and vitamin D (500 IU) supplementation. The primary study
outcome was change in lumbar spine BMD measured by DXA.
Secondary outcomes included changes in bone turnover markers,
pain and incidence of new vertebral fractures detected by magnetic
resonance imaging (MRI) and quantitative and semiquantitative
morphometry.
Results: At 9 months of follow-up, lumbar spine BMD increased
6.4% relative to baseline data. Bone turnover markers had statistically
significant increases. New vertebral fractures were observed
in only three patients. Clinical data showed significant pain relief.
No adverse treatment effects were observed during teriparatide
therapy period.
Conclusions: Vertebral fracture risk reduction is a primary
outcome measure in many studies of osteoporosis treatments.
Because teriparatide improves bone density and bone quality and
reduces the increasing risk of future fracture associated with a
history of fractures, this therapy may reduce the expensive and
disabling consequences of osteoporosis in women with a history of
fracture.