Bone density after teriparatide discontinuation in premenopausal idiopathic osteoporosis

Adi Cohen, Mafo Kamanda-Kosseh, Robert R. Recker, Joan M. Lappe, David W. Dempster, Hua Zhou, Serge Cremers, Mariana Bucovsky, Julie Stubby, Elizabeth Shane

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Context: Without antiresorptive therapy, postmenopausal women lose bone mass after teriparatide (TPTD) discontinuation; estrogen treatment prevents bone loss in this setting. It is notknown whether premenopausal women with regular menses lose bone mass after teriparatide discontinuation. Objective: This study aimed to test the hypothesis that normally menstruating premenopausal womenwith idiopathic osteoporosis (IOP) will maintain teriparatide-associated bone mineral density (BMD) gains after medication cessation. Design: Twenty-one premenopausal IOP women previously enrolled in an open-label pilot study of teriparatide (20 mcg for 18-24 mo), had substantial BMD increases at the lumbar spine (LS; 10.8 ± 8.3%), total hip (TH; 6.2 ± 5.6%), and femoral neck (7.6 ± 3.4%). For this study, BMD was remeasured 2.0± 0.6 years after teriparatide cessation. Participants: Fifteen women, who had gained 11.1 ± 7.2% at LS and 6.1 ± 6.5% at TH and were premenopausal at teriparatide completion, were followed without antiresorptive treatment. Results: Two years after completing teriparatide, BMD declined by 4.8± 4.3% (P = .0007) at the LS. In contrast, BMD remained stable at the femoral neck (-1.5 ± 4.2%) and TH (-1.1 ± 3.7%). Those who sustained LS bone loss>3%(-7.3±2.9%; n=10), did not differ from those with stable LS BMD (0.1 ± 1.1%; n=5) with regard to baseline body mass index, BMD at any site, or duration of followup, but were significantly older at re-evaluation (46 ± 3 vs 38 ± 7; P = .046), had larger increases in LS BMD during teriparatide treatment and higher cancellous bone remodeling on transiliac biopsy at baseline and completion of teriparatide treatment. Serum bone turnover markers did not differ at baseline or teriparatide completion, but tended to be higher at the re-evaluation timepoint in those with post-teriparatide bone loss. Conclusions: These findings lead us to conclude that premenopausal women with IOP, particularly those over 40, may require antiresorptive treatment to prevent bone loss after teriparatide.

Original languageEnglish
Pages (from-to)4208-4214
Number of pages7
JournalJournal of Clinical Endocrinology and Metabolism
Volume100
Issue number11
DOIs
StatePublished - Nov 1 2015

Fingerprint

Teriparatide
Bone Density
Osteoporosis
Bone
Minerals
Bone and Bones
Bone Remodeling
Femur Neck
Therapeutics
Menstruation
Hip
Biopsy

All Science Journal Classification (ASJC) codes

  • Biochemistry
  • Clinical Biochemistry
  • Endocrinology
  • Biochemistry, medical
  • Endocrinology, Diabetes and Metabolism

Cite this

Bone density after teriparatide discontinuation in premenopausal idiopathic osteoporosis. / Cohen, Adi; Kamanda-Kosseh, Mafo; Recker, Robert R.; Lappe, Joan M.; Dempster, David W.; Zhou, Hua; Cremers, Serge; Bucovsky, Mariana; Stubby, Julie; Shane, Elizabeth.

In: Journal of Clinical Endocrinology and Metabolism, Vol. 100, No. 11, 01.11.2015, p. 4208-4214.

Research output: Contribution to journalArticle

Cohen, A, Kamanda-Kosseh, M, Recker, RR, Lappe, JM, Dempster, DW, Zhou, H, Cremers, S, Bucovsky, M, Stubby, J & Shane, E 2015, 'Bone density after teriparatide discontinuation in premenopausal idiopathic osteoporosis', Journal of Clinical Endocrinology and Metabolism, vol. 100, no. 11, pp. 4208-4214. https://doi.org/10.1210/jc.2015-2829
Cohen, Adi ; Kamanda-Kosseh, Mafo ; Recker, Robert R. ; Lappe, Joan M. ; Dempster, David W. ; Zhou, Hua ; Cremers, Serge ; Bucovsky, Mariana ; Stubby, Julie ; Shane, Elizabeth. / Bone density after teriparatide discontinuation in premenopausal idiopathic osteoporosis. In: Journal of Clinical Endocrinology and Metabolism. 2015 ; Vol. 100, No. 11. pp. 4208-4214.
@article{6314559761ff412994ff1c5f5cc63409,
title = "Bone density after teriparatide discontinuation in premenopausal idiopathic osteoporosis",
abstract = "Context: Without antiresorptive therapy, postmenopausal women lose bone mass after teriparatide (TPTD) discontinuation; estrogen treatment prevents bone loss in this setting. It is notknown whether premenopausal women with regular menses lose bone mass after teriparatide discontinuation. Objective: This study aimed to test the hypothesis that normally menstruating premenopausal womenwith idiopathic osteoporosis (IOP) will maintain teriparatide-associated bone mineral density (BMD) gains after medication cessation. Design: Twenty-one premenopausal IOP women previously enrolled in an open-label pilot study of teriparatide (20 mcg for 18-24 mo), had substantial BMD increases at the lumbar spine (LS; 10.8 ± 8.3{\%}), total hip (TH; 6.2 ± 5.6{\%}), and femoral neck (7.6 ± 3.4{\%}). For this study, BMD was remeasured 2.0± 0.6 years after teriparatide cessation. Participants: Fifteen women, who had gained 11.1 ± 7.2{\%} at LS and 6.1 ± 6.5{\%} at TH and were premenopausal at teriparatide completion, were followed without antiresorptive treatment. Results: Two years after completing teriparatide, BMD declined by 4.8± 4.3{\%} (P = .0007) at the LS. In contrast, BMD remained stable at the femoral neck (-1.5 ± 4.2{\%}) and TH (-1.1 ± 3.7{\%}). Those who sustained LS bone loss>3{\%}(-7.3±2.9{\%}; n=10), did not differ from those with stable LS BMD (0.1 ± 1.1{\%}; n=5) with regard to baseline body mass index, BMD at any site, or duration of followup, but were significantly older at re-evaluation (46 ± 3 vs 38 ± 7; P = .046), had larger increases in LS BMD during teriparatide treatment and higher cancellous bone remodeling on transiliac biopsy at baseline and completion of teriparatide treatment. Serum bone turnover markers did not differ at baseline or teriparatide completion, but tended to be higher at the re-evaluation timepoint in those with post-teriparatide bone loss. Conclusions: These findings lead us to conclude that premenopausal women with IOP, particularly those over 40, may require antiresorptive treatment to prevent bone loss after teriparatide.",
author = "Adi Cohen and Mafo Kamanda-Kosseh and Recker, {Robert R.} and Lappe, {Joan M.} and Dempster, {David W.} and Hua Zhou and Serge Cremers and Mariana Bucovsky and Julie Stubby and Elizabeth Shane",
year = "2015",
month = "11",
day = "1",
doi = "10.1210/jc.2015-2829",
language = "English",
volume = "100",
pages = "4208--4214",
journal = "Journal of Clinical Endocrinology and Metabolism",
issn = "0021-972X",
publisher = "The Endocrine Society",
number = "11",

}

TY - JOUR

T1 - Bone density after teriparatide discontinuation in premenopausal idiopathic osteoporosis

AU - Cohen, Adi

AU - Kamanda-Kosseh, Mafo

AU - Recker, Robert R.

AU - Lappe, Joan M.

AU - Dempster, David W.

AU - Zhou, Hua

AU - Cremers, Serge

AU - Bucovsky, Mariana

AU - Stubby, Julie

AU - Shane, Elizabeth

PY - 2015/11/1

Y1 - 2015/11/1

N2 - Context: Without antiresorptive therapy, postmenopausal women lose bone mass after teriparatide (TPTD) discontinuation; estrogen treatment prevents bone loss in this setting. It is notknown whether premenopausal women with regular menses lose bone mass after teriparatide discontinuation. Objective: This study aimed to test the hypothesis that normally menstruating premenopausal womenwith idiopathic osteoporosis (IOP) will maintain teriparatide-associated bone mineral density (BMD) gains after medication cessation. Design: Twenty-one premenopausal IOP women previously enrolled in an open-label pilot study of teriparatide (20 mcg for 18-24 mo), had substantial BMD increases at the lumbar spine (LS; 10.8 ± 8.3%), total hip (TH; 6.2 ± 5.6%), and femoral neck (7.6 ± 3.4%). For this study, BMD was remeasured 2.0± 0.6 years after teriparatide cessation. Participants: Fifteen women, who had gained 11.1 ± 7.2% at LS and 6.1 ± 6.5% at TH and were premenopausal at teriparatide completion, were followed without antiresorptive treatment. Results: Two years after completing teriparatide, BMD declined by 4.8± 4.3% (P = .0007) at the LS. In contrast, BMD remained stable at the femoral neck (-1.5 ± 4.2%) and TH (-1.1 ± 3.7%). Those who sustained LS bone loss>3%(-7.3±2.9%; n=10), did not differ from those with stable LS BMD (0.1 ± 1.1%; n=5) with regard to baseline body mass index, BMD at any site, or duration of followup, but were significantly older at re-evaluation (46 ± 3 vs 38 ± 7; P = .046), had larger increases in LS BMD during teriparatide treatment and higher cancellous bone remodeling on transiliac biopsy at baseline and completion of teriparatide treatment. Serum bone turnover markers did not differ at baseline or teriparatide completion, but tended to be higher at the re-evaluation timepoint in those with post-teriparatide bone loss. Conclusions: These findings lead us to conclude that premenopausal women with IOP, particularly those over 40, may require antiresorptive treatment to prevent bone loss after teriparatide.

AB - Context: Without antiresorptive therapy, postmenopausal women lose bone mass after teriparatide (TPTD) discontinuation; estrogen treatment prevents bone loss in this setting. It is notknown whether premenopausal women with regular menses lose bone mass after teriparatide discontinuation. Objective: This study aimed to test the hypothesis that normally menstruating premenopausal womenwith idiopathic osteoporosis (IOP) will maintain teriparatide-associated bone mineral density (BMD) gains after medication cessation. Design: Twenty-one premenopausal IOP women previously enrolled in an open-label pilot study of teriparatide (20 mcg for 18-24 mo), had substantial BMD increases at the lumbar spine (LS; 10.8 ± 8.3%), total hip (TH; 6.2 ± 5.6%), and femoral neck (7.6 ± 3.4%). For this study, BMD was remeasured 2.0± 0.6 years after teriparatide cessation. Participants: Fifteen women, who had gained 11.1 ± 7.2% at LS and 6.1 ± 6.5% at TH and were premenopausal at teriparatide completion, were followed without antiresorptive treatment. Results: Two years after completing teriparatide, BMD declined by 4.8± 4.3% (P = .0007) at the LS. In contrast, BMD remained stable at the femoral neck (-1.5 ± 4.2%) and TH (-1.1 ± 3.7%). Those who sustained LS bone loss>3%(-7.3±2.9%; n=10), did not differ from those with stable LS BMD (0.1 ± 1.1%; n=5) with regard to baseline body mass index, BMD at any site, or duration of followup, but were significantly older at re-evaluation (46 ± 3 vs 38 ± 7; P = .046), had larger increases in LS BMD during teriparatide treatment and higher cancellous bone remodeling on transiliac biopsy at baseline and completion of teriparatide treatment. Serum bone turnover markers did not differ at baseline or teriparatide completion, but tended to be higher at the re-evaluation timepoint in those with post-teriparatide bone loss. Conclusions: These findings lead us to conclude that premenopausal women with IOP, particularly those over 40, may require antiresorptive treatment to prevent bone loss after teriparatide.

UR - http://www.scopus.com/inward/record.url?scp=84958636853&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84958636853&partnerID=8YFLogxK

U2 - 10.1210/jc.2015-2829

DO - 10.1210/jc.2015-2829

M3 - Article

VL - 100

SP - 4208

EP - 4214

JO - Journal of Clinical Endocrinology and Metabolism

JF - Journal of Clinical Endocrinology and Metabolism

SN - 0021-972X

IS - 11

ER -