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Premenopausal women with idiopathic osteoporosis may need antiresorptive therapy after Forteo
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In premenopausal women with idiopathic osteoporosis, post-Forteo antiresorptive treatment may be needed to maintain Forteo-associated gains in bone mineral density, according to recent study findings.
In the study, Adi Cohen, MD, MHS, of Columbia University, and colleagues evaluated 15 premenopausal women aged 20 to 48 years in an open-label pilot study of Forteo (teriparatide [rDNA origin], Eli Lilly & Company) treatment. Before the study, participants were treated with teriparatide 20 µg daily. BMD measurements were taken 2 years after discontinuing treatment.
While on teriparatide, participants had mean increases of 11.1% in lumber spine BMD and 6.1% in total hip BMD.
The researchers found a 4.8% decrease in lumbar spine BMD (P = .0007) at 2 years after teriparatide treatment. Conversely, femoral neck BMD and total hip BMD remained stable.
There was no difference between participants with lumber spine BMD decline (> 3%) and those who maintained stable lumbar spine BMD in terms of baseline BMI, BMD at any location or duration of follow-up. However, those with lumbar spine BMD decline were significantly older at the 2-year reassessment (P = .046). Additionally, those with lumbar spine BMD declines of 3% or more also had larger increases in lumbar spine BMD during teriparatide treatment, as well as higher cancellous bone remodeling on baseline transiliac biopsy and at the conclusion of teriparatide treatment. While there were no differences in serum bone turnover markers at baseline or at conclusion of teriparatide treatment, a tendency was observed for these markers to be higher at follow-up in those with posttreatment bone loss.
According to the researchers, antiresorptive treatments should be considered for all premenopausal women finishing a course of teriparatide treatment, especially in women over 40 years of age and those with substantial bone gain while on teriparatide.
“However, because of this study’s small sample size, additional larger scale prospective studies are needed to make firm conclusions regarding post-teriparatide treatment recommendations,” the researchers wrote. – by Jennifer Byrne
Disclosure: Cohen report no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.
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