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Teriparatide fails to heal atypical femur fractures, despite improved bone quality
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Teriparatide treatment for 24 months was effective in increasing spine bone mineral density in women with previous atypical femur fractures, but the therapy had no observed effect on the healing of such fractures, according to researchers.
Nelson B. Watts, MD, director of the Mercy Health Osteoporosis and Bone Health Services in Cincinnati, and colleagues evaluated 14 women (mean age, 68.3 years) with atypical femur fractures previously treated with bisphosphonates to determine the response to 24 months of treatment with teriparatide (Forteo, Lilly) on BMD, trabecular bone score, bone turnover markers and fracture healing.
At baseline, participants exhibited a wide variation in BMD, trabecular bone scores and bone turnover markers.
Spine BMD was 0.933 g/cm2 at baseline. Researchers observed a nonsignificant increase of 3.1% at month 12 of teriparatide treatment and a significant increase of 6.1% at month 24 (P < .05).
Baseline total hip BMD was 0.807 g/cm2, and trabecular bone score was 1.3 g/cm2. At months 12 and 24 of treatment, no significant differences were observed in total hip BMD or trabecular bone score from baseline.
After 24 months of teriparatide treatment, six patients showed fracture healing, three showed partial healing and two were unchanged.
“The main implication ... is that teriparatide cannot be relied on for the healing of atypical femur fractures, but other responses to teriparatide seem to be intact in these patients,” Watts told Endocrine Today. “Ideally a large randomized trial would be conducted; however, these atypical femur fractures are uncommon — [it is] difficult to get a large number of them in one place — and a placebo arm would be unethical in patients at high risk for osteoporotic fractures who are commonly treated with teriparatide, so it is unlikely that such a trial would be done.”
According to the researchers, fracture healing and reducing the risk for fractures due to osteoporosis are two things to take into account when considering teriparatide treatment.
“Our data support the anabolic effects of teriparatide in this context, with improvement in anabolic bone turnover markers and lumbar spine BMD,” the researchers wrote. “However, we did not find a consistent effect of teriparatide on healing of the [atypical femur fractures].” – by Amber Cox
Disclosure: Watts reports various financial ties with AbbVie, Amgen, Janssen, Merck, OsteoDynamics, Radius Health, Sanofi and Shire. Please see the full study for a list of all other authors’ relevant financial disclosures.
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