The Joint Annual Scientific Meetings of the Endocrine Society of Australia and the Society for Reproductive Biology 2018

Patients receiving teriparatide in a tertiary referral centre have multiple co-morbidities and fractures but a similar bone mineral density response to published literature (#209)

Eleanor Danek 1 2 , Grace Mann 2 , Hanh Nguyen 1 2 , Phillip Wong 2 3 , Peter J Fuller 2 3 , Amanda Vincent 2 4 , Francis Milat 1 2 3
  1. Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, VIC, Australia
  2. Department of Endocrinology, Monash Health, Melbourne, VIC, Australia
  3. Hudson Institute of Medical Research, Melbourne, VIC, Australia
  4. Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia

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.