Teriparatide therapy beneficial in pregnancy- and lactation-induced osteoporosis
Women with pregnancy- and lactation-induced osteoporosis who experienced multiple vertebral fractures saw a 15% improvement in bone mineral density at the lumbar spine after 1 year of daily teriparatide therapy, as well as improvements in bone turnover markers vs. similar women who declined the drug, study data show.
“The actual incidence of pregnancy- and lactation-induced osteoporosis and vertebral fractures is quite low; however, once it happens, the pain and discomfort that women affected have to bear is in great amount,” Yumie Rhee, MD, PhD, of the Endocrine Research Institute at Yonsei University College of Medicine in Seoul, South Korea, told Endocrine Today. “Therefore, despite the ultimate recovery of bone mass and pain, the process is quite slow, and it is necessary to find the faster and more effective way to recover.”
Rhee and colleagues analyzed data from 32 patients with pregnancy- and lactation-induced osteoporosis who presented with multiple vertebral fractures between 2007 and 2015 (mean age, 31 years; mean BMI, 20.3 kg/m²; no previous fracture history). Within the cohort, 27 women were prescribed 20 µg daily, subcutaneous injections of teriparatide (Forteo, Eli Lilly) for 12 months; five women who rejected the therapy served as controls during the same period. Researchers assessed changes in BMD at the lumbar spine and proximal femur, as well as bone turnover markers (assessed every 3 months), from baseline to 12 months.
Among all participants, the median duration between delivery date and documentation of fractures via imaging was 2 months; median lactation duration was 3 months; all but two women were primiparas. Median duration between first identification of fractures and initiation of therapy was 1 month.
At 12 months, BMD at the lumbar spine improved in both groups, although a marked improvement was observed in the teriparatide group (mean, 16.2% vs. 3.5%; P = .002). Between-group differences were smaller after adjusting for age and baseline BMD at the lumbar spine, but remained significantly greater for the teriparatide arm (mean, 15.5% vs. 7.5% improvement). Researchers also observed improvements in femoral neck and total hip BMD at 12 months for women prescribed teriparatide (mean improvements of 5.4% and 5.2%, respectively). There were no new fragility fractures detected during follow-up.
Women prescribed teriparatide also saw improvements in osteocalcin and C-telopeptide of type 1 collagen (CTX). For osteocalcin, serum levels peaked at 3 months (mean increase of 86.6%), before decreasing toward baseline values at 6, 9 and 12 months. Serum CTX increased more gradually, peaking at 6 months (mean increase of 46.4%) before decreasing back to baseline values, according to researchers.
“Teriparatide could be a good alternative treatment in certain patients with pregnancy- and lactation-induced osteoporosis with multiple compression vertebral fractures,” Rhee said. “Thus, finding and recognizing the women with high risks for pregnancy- and lactation-induced osteoporosis with fractures could be important to the young women wishing to breast-feed.” – by Regina Schaffer
Disclosures: The authors report no relevant financial disclosures.