Changes in bone mineral density and bone turnover markers during treatment with teriparatide in pregnancy- and lactation-associated osteoporosis

Summary

Context

Teriparatide (TPTD) therapy has been proposed as a potential treatment strategy in severe cases of pregnancy- and lactation-associated osteoporosis (PLO) characterised by the occurrence of fragility fractures in the third trimester or early postpartum.

Objective

To investigate the changes in bone mineral density (BMD) and bone turnover markers in patients with PLO with and without TPTD treatment.

Design

Retrospective cohort study.

Patients

Thirty-two patients with PLO who presented with multiple vertebral fractures to a tertiary institution between 2007 and 2015 were included.

Measurements

Changes in BMD at the lumbar spine (LSBMD) and proximal femur after 12 months of daily subcutaneous injections of 20 μg TPTD (n = 27) were assessed. Subjects who rejected the TPTD treatment were used as controls (n = 5).

Results

LSBMD increased in both subjects treated with TPTD and controls, with greater increases in the TPTD group (15.5 ± 6.6% vs. 7.5 ± 7.1%, p = 0.020) after adjustment for age and baseline LSBMD. During follow-up, serum levels of osteocalcin (OCN) and C- telopeptide of type I collagen (CTX) increased significantly in the TPTD group. In multivariate linear regression models, TPTD treatment (adjusted β = 7.92, p=0.032) and younger age (adjusted β = 1.06, p = 0.046), but not baseline LSBMD, body mass index, serum OCN level, and CTX level, were independently associated with greater increases in LSBMD.

Conclusions

In patients with PLO, LSBMD at 12 months increased in both the TPTD-treated and control groups. TPTD treatment and younger age were associated with greater increases in LSMBD irrespective of baseline LSBMD.

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