Literature review: The effects of teriparatide therapy at the hip in patients with osteoporosis

Abstract

Teriparatide is a skeletal anabolic treatment for patients with osteoporosis at high risk for fracture. Because adequate clinical trials have not yet been conducted to assess the efficacy of teriparatide for reducing the risk of hip fracture, we review here the literature regarding how treatment with teriparatide affects the hip in patients with osteoporosis. Teriparatide increases cancellous bone volume, improves bone architecture, and - uniquely among osteoporosis treatments - increases cortical thickness and cortical porosity. By bone scan and positron emission tomography, teriparatide increases bone formation throughout the skeleton, including the hip. Consistent with these findings, studies using dual-energy X-ray absorptiometry and quantitative computed tomography for longitudinal assessment of changes at the hip have consistently shown increases in areal and volumetric bone mineral density, cortical thickness, and finite element-estimated hip strength in patients treated with teriparatide. Finally, in clinical fracture-outcome trials, treatment with teriparatide has been shown to reduce the risk of nonvertebral fracture, a composite endpoint that includes hip fracture. Taken together, this body of evidence suggests that teriparatide positively affects the hip in patients with osteoporosis.

Comparison of treatment effects of teriparatide and the bisphosphonate risedronate in an aged, osteopenic, ovariectomized rat model under various clinical conditions

“…Nakamura et al [9] also reported that weekly teriparatide administration led to an approximately 2 to 3 % increase in the femoral neck BMD. Adequate clinical trials have not yet been conducted to assess the efficacy of weekly teriparatide for reducing the risk of nonvertebral fractures, but some clinical studies reported that weekly administration of teriparatide increased cortical bone thickness [39][40][41]. However, we were unable to evaluate the effects of these agents on cortical bone in the OVX rats in the present study.…”

Physiologic Activity of Bisphosphonates – Recent Advances

“…Parathyroid hormone (PTH) is an 84-amino acid polypeptide that plays an important role in calcium regulation and bone remodeling. Its 34-amino acid analog Teriparatide [90] retains most of the functions of PTH and is an FDA approved drug against osteoporosis. However, being a peptide, it is unstable in body fluids and is readily hydrolyzed by proteinases.…”

Teriparatide Versus Alendronate for the Preservation of Bone Mineral Density After Total Hip Arthroplasty – A randomized Controlled Trial

“…Due to the relationship between bone ingrowth and osteoblast activity [11], it may be reasonable to activate osteoblast after implantation. Recently, advantages of teriparatide for the treatment of osteoporosis have been acknowledged [12], even comparing with the bisphosphonate, alendronate [13,14]. After THA, teriparatide may be desirable at the point of implant fixation [15] because of its ability to activate osteoblasts to aid osteointegration [11].…”