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
N1 - Funding Information:
Address all correspondence and requests for reprints to: Adi Cohen MD, MHS, Columbia University, College of Physicians & Surgeons, Department of Medicine, PH8-864, 630 West 168th Street, New York, NY 10032. E-mail: ac1044@columbia.edu. This study was registered in ClinicalTrials.gov as trial number NCT01440803. These treatment and follow-up studies were investigator initiated. The principal investigators designed and conducted these studies. Eli Lilly supplied teriparatide and provided financial support for the treatment study. These studies were also supported by Grants R01 AR49896 (to E.S.), 2K24 AR052665 (to E.S.), and 1K23 AR054127 (to A.C.); the National Center for Research Resources and the National Center for Advancing Translational Sciences; National Institutes of Health through Grant UL1 RR024156; and the Thomas L. Kempner Jr. and Katheryn C. Patterson Foundation. Disclosure Summary: E.S. is the Principal Investigator of a grant from Eli Lilly to Columbia University that provided partial funding for this study. R.R.R. and D.W.D. have consulted for Eli Lilly and their total compensation exceeds $5000. D.W.D. has received grant support from Eli Lilly. A.C., M.K.-K., J.M.L., H.Z., S.C., M.B., J.S. have nothing to declare.
PY - 2015/11
Y1 - 2015/11
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.
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U2 - 10.1210/jc.2015-2829
DO - 10.1210/jc.2015-2829
M3 - Article
C2 - 26358172
AN - SCOPUS:84958636853
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 -