Issue: March 2014
January 29, 2014
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Teriparatide increased BMD, bone strength in mild osteogenesis imperfecta

Issue: March 2014
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Teriparatide therapy significantly increased hip and spine bone mineral density and estimated bone strength in adults with mild osteogenesis imperfecta, recent data suggest.

Perspective from Joel S. Finkelstein , MD

“These results indicated that despite an underlying genetic defect in [osteogenesis imperfecta] that impairs bone matrix synthesis and results in osteoblastic dysfunction and remodeling abnormalities, anabolic therapy is capable of increasing bone formation and bone mass,” researchers wrote.

Patients with osteogenesis imperfecta (n=79) were randomly assigned to teriparatide 20 mcg (Forteo, Eli Lilly and Company) or placebo for 18 months.

Those who were assigned to teriparatide displayed an increased percentage change in areal BMD of the lumbar spine (6.1%) compared with patients assigned to placebo (2.8%; P<.05), according to data.

There was a 3% change to the vertebral BMD (18%) and bone strength (15%) in those assigned to teriparatide. Conversely, vertebral BMD (–5%) and bone strength (–2%) decreased in those assigned to placebo (P<.05), researchers wrote.

Teriparatide therapy was associated with a 10% increase in serum procollagen type 1 N-terminal propeptide (135%) and urine collagen N-telopeptide (64%) levels, according to data. These elevated levels were not as significant in other forms of osteogenesis imperfecta, whereas the most significant findings were observed among patients with mild forms of the disease.

Eleven patients (29%) assigned to teriparatide reported fractures during the study (OR=0.73; 95% CI, 0.28-1.9) compared with those assigned to placebo (36%). However, changes to areal BMD were not associated with the likelihood of fractures, according to data.

“These data should prompt larger trials to evaluate whether anabolic treatment results in a reduction in the burden of fractures in those patients. On the other hand, our results suggest that anabolic therapies may be less effective in patients with more severe forms of [osteogenesis imperfecta], and future studies should specifically assess the usefulness of therapies in light of disease severity,” researchers wrote.

Disclosure: Orwoll consults with Eli Lilly and Company. Two researchers report financial ties with ON Diagnostics. All other researchers report no relevant financial disclosures.