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.