Responses to Therapy With Teriparatide in Sufferers With Atypical Femur Fractures Beforehand Handled With Bisphosphonates.
J Bone Miner Res. 2017 Could;32(5):1027-1033
Authors: Watts NB, Aggers D, McCarthy EF, Savage T, Martinez S, Patterson R, Carrithers E, Miller PD
If oversuppression of bone turnover defined the affiliation between bisphosphonate use and atypical subtrochanteric femur fractures (AFF), this could possibly be reversed with anabolic therapy comparable to teriparatide. We carried out a potential, open-label examine in sufferers beforehand handled with bisphosphonates who sustained AFF, inspecting the response to 24-month therapy with teriparatide on bone mineral density (BMD), trabecular bone rating (TBS), bone turnover markers (BTM), and fracture therapeutic in addition to quantitative histomorphometry. We studied 14 sufferers. Baseline BMD, BTM, and TBS various extensively. On preliminary bone biopsies, 12 of 14 sufferers confirmed tetracycline labels, however mineralizing floor/bone floor was beneath printed regular values in all however 2. Lumbar backbone BMD elevated considerably at month 24 (6.1%?±?four.three%, p < zero.05 versus baseline), whereas complete hip BMD and TBS didn’t change considerably. Adjustments in BTM occurred as reported beforehand for sufferers with out AFF handled with teriparatide after prior bisphosphonate therapy. At month 24, fractures have been healed in 6 sufferers, confirmed partial therapeutic in three, have been unchanged in 2, and confirmed nonunion in 1. In a affected person with two fractures, the fracture that occurred earlier than teriparatide therapy was reported as healed, however the fracture that occurred whereas on therapy confirmed solely partial therapeutic. Bisphosphonate-treated sufferers who maintain AFF present heterogeneity of bone turnover. Therapy with teriparatide resulted in will increase in BTM and lumbar backbone BMD, as has been reported for sufferers with out AFF. There was no vital impact of teriparatide on hip BMD, mineralizing floor to bone floor (MS/BS), or TBS and no constant impact on fracture therapeutic. Within the context of a affected person who has skilled an AFF after receiving bisphosphonate therapy, remedy with teriparatide for 24 months can be anticipated to extend BMD and BTM (and doubtless cut back the danger of fractures ensuing from osteoporosis) however shouldn’t be relied on to help in therapeutic of the AFF. © 2017 American Society for Bone and Mineral Analysis.
PMID: 28071822 [PubMed – indexed for MEDLINE]