Background Teriparatide is an anabolic agent that has been shown to increase bone mineral density (BMD) and reduce the risk of fracture. Despite its unique mechanism, there are still few reviews respecting any differences on treatment efficacy in the different types of osteoporosis.
Objectives To evaluate if there are differences between primary (OP1) and secondary (OP2) osteoporosis (glucocorticoid-induced osteoporosis and/or secondary to chronic inflammatory diseases), and the several initial indications for treatment, concerning the markers of bone turnover (MBT) and bone mineral density changes, on patients under teriparatide treatment.
Methods All patients treated with teriparatide for osteoporosis at our centre were retrospectively evaluated. The indications for treatment were listed as: lumbar spine T-score ≤-4 (13 patients); lumbar spine T-score ≤-3 and presence of radiographic vertebral fractures (32 patients); and others (18 patients). BMD values at baseline and 18 months were obtained by DEXA with a LUNAR Expert 1320. The MBT measured at baseline, 3 and 18 months were: β-C-telopeptide of collagen 1 crosslinks, osteocalcin, alkaline phosphatase and 25(OH) vitamin D3. MBT and BMD variations between baseline and 18 months were tested according to the presence of OP1 or OP2, and indications for treatment, using non-parametric tests (SPSS 21.0 for statistical data analysis).
Results Sixty three patients were evaluated (58 women), 25 (39,7%) with OP1, and 38 (60,3%) with OP2. Comparing to OP2, OP1 was significantly associated (p<0,050) with higher gains of BMD at Wards triangle (5,5% vs 1,3%), total hip (3,5% vs 0,3%) and lumbar spine (21,65% vs 9,9%). There were no differences concerning MBT in OP1 vs OP2.
Regarding the several treatment indications, there were no differences in terms of MBT. Concerning BMD variations, the group with lumbar spine T-score <-4 was the only that showed higher gains in bone mass, namely at the lumbar spine BMD (22,8% vs 8,9% g/cm2).
Conclusions OP1 seems to have better response than OP2 to teriparatide treatment at total hip, lumbar spine and Wards triangle in terms of BMD gains.
The indication for treatment does not appear to influence the results, both in terms of BMD gains and MBT changes, with the exception of those patients with lumbar spine T-score<-4, who exhibited greater gains at lumbar spine BMD.
Disclosure of Interest None declared
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