BACKGROUND: Teriparatide is subsidised for patients with severe osteoporosis who fracture despite anti-resorptive therapy. Clinical trials with teriparatide demonstrate improvements in bone mineral density (BMD) and fracture risk reduction but the application of these findings to real-world practice is uncertain.
OBJECTIVE: To characterise patients prescribed teriparatide in a tertiary hospital and evaluate teriparatide completion and consolidation with anti-resorptive therapy.
METHODS: Retrospective audit of patients commencing teriparatide between January 2014-April 2018. Clinical information was extracted from medical records. Analysis included calculation of co-morbidity score (Silverman SL. et al. Osteoporosis International, 2016) and descriptive statistics.
RESULTS: Of 49 patients commencing teriparatide, most were female (82%), post-menopausal (97%), had a median (IQR) age of 70 (58,76) years and received bisphosphonates prior to teriparatide (83%). All patients had multiple fragility fractures, with ≥5 and ≥10 fragility fractures observed in 46% and 10% respectively. Median (IQR) pre-treatment spine and femoral neck T-scores were -2.6 (-3.3,-1.1) and -2.8 (-3.5,-1.9) respectively. Median co-morbidity score was 4 (2,5). In 2018, 22/49 patients were currently taking, 14/49 completed and 4/49 patients discontinued teriparatide (inadequate information for 9/49). Reasons for teriparatide discontinuation were: death (n=2), side-effects (n=1) and non-compliance (n=1). Anti-resorptive therapy post-teriparatide was not received within 3 months in 2/14 patients due to missed appointment (n=1) and loss to follow-up (n=1). After a median (IQR) teriparatide duration of 16 months (13,18), the median change in lumbar spine and femoral neck BMD was: +0.055g/cm2 (+0.020,+0.114) and +6.8% (+2.2,+12.6) at the lumbar spine and +0.027 g/cm2 (+0.004,+0.038) and +4.1% (+0.5, +4.8) at the femoral neck.
CONCLUSIONS: Patients receiving teriparatide in a tertiary hospital have multiple fractures, low BMD and a high co-morbidity index. The BMD increase is consistent with clinical trials of teriparatide in patients with prior bisphosphonate exposure. Care should be taken to ensure timely antiresorptive therapy following teriparatide completion.