Teriparatide for Idiopathic Osteoporosis in Premenopausal Women: A Pilot Study

Cohen, Adi; Stein, Emily; Recker, Robert R.; Lappe, Joan M.; Dempster, David W.; Zhou, Hua; Cremers, Serge; McMahon, Donald J.; Nickolas, Thomas L.; Müller, Ralph; Zwahlen, Alexander; Young, Polly; Stubby, Julie; Shane, Elizabeth

doi:10.1210/jc.2013-1172

Cited by 78 publications

(79 citation statements)

References 60 publications

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“…These goals appear ever more unreachable dealing with the proposed methodologies, ever more sophisticate and developed without taking into account feasibility of their application in clinical practice. As the result, in 2013 we still find clinical studies on TBA characterization performed on bioptic specimens and analyzed by quantitative histomorphometric method in microCT images [95] . CT techniques represent a precious contribution to the knowledge of bone mechanical properties useful for a more precise evaluation of fracture risk.…”

Section: Discussionmentioning

confidence: 99%

Fractal lacunarity of trabecular bone and magnetic resonance imaging: New perspectives for osteoporotic fracture risk assessment

Alimazighi¹

2015

WJO

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Osteoporosis represents one major health condition for our growing elderly population. It accounts for severe morbidity and increased mortality in postmenopausal women and it is becoming an emerging health concern even in aging men. Screening of the population at risk for bone degeneration and treatment assessment of osteoporotic patients to prevent bone fragility fractures represent useful tools to improve quality of life in the elderly and to lighten the related socio-economic impact. Bone mineral density (BMD) estimate by means of dualenergy X-ray absorptiometry is normally used in clinical practice for osteoporosis diagnosis. Nevertheless, BMD alone does not represent a good predictor of fracture risk. From a clinical point of view, bone microarchitecture seems to be an intriguing aspect to characterize bone alteration patterns in aging and pathology. The widening into clinical practice of medical imaging techniques and the impressive advances in information technologies together with enhanced capacity of power calculation have promoted proliferation of new methods to assess changes of trabecular bone architecture (TBA) during aging and osteoporosis. Magnetic resonance imaging (MRI) has recently arisen as a useful tool to measure bone structure in vivo . In particular, high-resolution MRI techniques have introduced new perspectives for TBA characterization by non-invasive non-ionizing methods. However, texture analysis methods have not found favor with clinicians as they produce quite a few parameters whose interpretation is difficult. The introduction in biomedical field of paradigms, such as theory of complexity, chaos, and fractals, suggests new approaches and provides innovative tools to develop computerized methods that, by producing a limited number of parameters sensitive to pathology onset and progression, would speed up their application into clinical practice. Complexity of living beings and fractality of several physio-anatomic structures suggest fractal analysis as a promising approach to quantify morphofunctional changes in both aging and pathology. In this particular context, fractal lacunarity seems to be the proper tool to characterize TBA texture as it is able to describe both discontinuity of bone network and sizes of bone marrow spaces, whose changes are an index of bone fracture risk. In this paper, an original method of MRI texture analysis, based on TBA fractal lacunarity is described and discussed in the light of new perspectives for early diagnosis of osteoporotic fractures.

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Section: Discussionmentioning

confidence: 99%

Fractal lacunarity of trabecular bone and magnetic resonance imaging: New perspectives for osteoporotic fracture risk assessment

Alimazighi¹

2015

WJO

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“…Selective estrogen receptor agonists are not recommended in young women due to bone loss. On the other hand, teriparatide use is recommended in such cases in many recent literatures [18]. Any fracture history was not reported in this case before, only intake of calcium and vitamin D has been hitherto applied.…”

Section: Discussionmentioning

confidence: 82%

Sneezing: A Rare Cause of Sacral Insufficiency Fracture in a Young Osteoporotic Woman

Erdem

Neyisci

2017

J Med Cases

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Sacral insufficiency fractures are rare and usually overlooked in patients presenting with low back pain without any trauma. The history and physical examination are not specific, and conventional radiographs are inadequate, thus requiring further radiological imaging as MRI, bone scintigraphy and CT. The treatment includes rest, pain control and physiotherapy. In this report, sneezing is stated as the cause of sacral insufficiency fracture in a young osteoporotic woman.

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“…As noted previously, several studies point to the role of bone remodeling markers 8,9,11,12,15,16,19 to predict the level of response to long-term bone forming treatment 9,12,19 , especially when the PINP bone formation marker is used 12,16 . In a post-hoc study, Eastell et al 13 note that by quantifying the change in PINP at 3 months of starting teriparatide treatment allowed for the indentification of long-term patients who presented a significant BMD increase, particularly if the increase was greater than 10 ng/mL 9,[12][13][14][15][16] .…”

Section: Discussionmentioning

confidence: 92%

“…In fact, recent studies also indicate an increased incidence of inadequate response after bone forming treatment, rising to 32% of patients in the study by Chen et al 9 . This suggests that baseline BMD and bone remodeling (especially low PINP values) and previous treatment with bisphosphonates could influence the magnitude of therapeutic response to these agents [8][9][10][11]18 . In our study, although differences in the rate and duration of prior bisphosphonate treatment between both groups of patients were not significant, over 90% of patients with inadequate response to treatment had had prior bone forming treatment with bisphosphonates for an average 7 years, suggesting a possible inhibitory effect of this type of treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, this agent is especially recommended for patients with severe osteoporosis and multiple fractures and/or inadequate response to other treatments 7 . However, as with antiresorptive treatments in clinical practice, some patients present a lack of response to this treatment, with figures ranging from 8% to 32% [8][9][10] . While the cause of this poor response to bone forming treatment is unclear, factors such as bone turnover and BMD baseline value, previous use of bisphosphonates and the initial response of bone turnover markers to treatment, have been linked to the magnitude of the BMD response to this long-term therapy 8,9,11,12 .…”

Section: Introductionmentioning

confidence: 99%

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Factores relacionados con la respuesta inadecuada al tratamiento osteoformador (teriparatida/PTH 1-84) en pacientes con osteoporosis severa: resultados preliminares

Gifre¹,

Monegal²,

Filella³

et al. 2015

Rev Osteoporos Metab Miner

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SummaryThe aim of this study was to evaluate the long-term bone mineral density (BMD) response rate to osteoanabolic treatment in patients with severe osteoporosis and the factors related to "inadequate" response (IR). Methods: 49 patients (46F:3M) with a mean age of 69.5±11.1 years treated with teriparatide (41) or PTH1-84 (8) during 18/24months were included (84% had vertebral fractures and 84% had previously received bisphosphonates). Previous skeletal fractures and antiosteoporotic treatment, risk factors and cause of osteoporosis were recorded in all patients. Bone turnover markers (BTM) and 25-OH vitamin D (25OHD) levels were assessed before and at 3, 6, 12 and 18/24 months. Lumbar and femoral BMD and spinal X-ray were assessed at baseline and at 12 and 18/24 months. IR was defined by a lumbar BMD change <3% at 18/24 months. Results: 29% of patients showed IR to therapy. No significant differences were observed in age, baseline BMD and BTM and 25OHD levels between patients with or without IR. 92% of IR patients had been previously treated with bisphosphonates (vs 79%, p=0.34) during 7±4.8 years (vs 4.9±4.2 years, p=0.19). No significant differences were observed between groups in the magnitude of changes in BTM throughout the study. Conclusions: 29% of patients with severe osteoporosis presented IR to osteoanabolic therapy. Although no predictive factors related to this finding were identified, previous prolonged therapy with bisphosphonates may play a role.

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Teriparatide for Idiopathic Osteoporosis in Premenopausal Women: A Pilot Study

Abstract: Teriparatide was associated with increased spine and hip BMD and improved trabecular microarchitecture and stiffness at the iliac crest in the majority of women with IOP.

Cited by 78 publications

References 60 publications

Fractal lacunarity of trabecular bone and magnetic resonance imaging: New perspectives for osteoporotic fracture risk assessment

Fractal lacunarity of trabecular bone and magnetic resonance imaging: New perspectives for osteoporotic fracture risk assessment

Sneezing: A Rare Cause of Sacral Insufficiency Fracture in a Young Osteoporotic Woman

Factores relacionados con la respuesta inadecuada al tratamiento osteoformador (teriparatida/PTH 1-84) en pacientes con osteoporosis severa: resultados preliminares

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