The effectiveness of teriparatide in the clinical practice—attenuation of the bone mineral density outcome by increasing age and bisphosphonate pretreatment

Abstract

Background. Teriparatide is a potent anabolic agent for severe osteoporosis.

Objectives. A primary objective of this retrospective study was to define the efficacy of teriparatide in terms of bone mineral density (BMD) changes and relief of back pain in clinical practice.

Methods. The patient population comprises 119 osteoporotic patients treated with teriparatide for median 539 (range 179–926) days.

Results. The mean BMD gain was 0.9% in the total hip (P = 0.0075), 2.1% in the femoral neck (P = 0.0006), and 8.5% in the lumbar spine (P = 0.0085). In the whole patient population age associated inversely with BMD changes in the total hip (P = 0.019) and in the femoral neck (P = 0.0036). A history of significant bisphosphonate pretreatment (n = 90) reduced BMD response in the total hip (P = 0.039). The total exposure of any prior bisphosphonate was negatively correlated with BMD response in the total hip (P = 0.0421). Half of the patients reported relief of back pain during the treatment. Leg pain, nausea, and dizziness were most frequent adverse concerns.

Conclusions. Teriparatide works in clinical practice as well as in clinical trials. Younger subjects benefited more than older patients from teriparatide in the total hip and in the femoral neck. Bisphosphonate pretreatment attenuated teriparatide-induced BMD gain.

Key words::

• Back pain
• bisphosphonate
• bone mineral density
• osteoporosis
• teriparatide

Acknowledgements

We thank doctors Heikki Valleala, Juhani Koski, and Anja Orvola for additional help in collecting patients for the study.

Declaration of interest: The study costs were covered by a grant from Eli Lilly.