Bone Density After Teriparatide Discontinuation in Premenopausal Idiopathic Osteoporosis

Abstract

Context: Without antiresorptive therapy, postmenopausal women lose bone mass after teriparatide (TPTD) discontinuation; estrogen treatment prevents bone loss in this setting. It is not known whether premenopausal women with regular menses lose bone mass after teriparatide discontinuation.

Objective: This study aimed to test the hypothesis that normally menstruating premenopausal women with idiopathic osteoporosis (IOP) will maintain teriparatide-associated bone mineral density (BMD) gains after medication cessation.

Design: Twenty-one premenopausal IOP women previously enrolled in an open-label pilot study of teriparatide (20 mcg for 18-24 mo), had substantial BMD increases at the lumbar spine (LS; 10.8 ± 8.3%), total hip (TH; 6.2 ± 5.6%), and femoral neck (7.6 ± 3.4%). For this study, BMD was remeasured 2.0 ± 0.6 years after teriparatide cessation.

Participants: Fifteen women, who had gained 11.1 ± 7.2% at LS and 6.1 ± 6.5% at TH and were premenopausal at teriparatide completion, were followed without antiresorptive treatment.

Results: Two years after completing teriparatide, BMD declined by 4.8 ± 4.3% (P = .0007) at the LS. In contrast, BMD remained stable at the femoral neck (-1.5 ± 4.2%) and TH (-1.1 ± 3.7%). Those who sustained LS bone loss >3% (-7.3 ± 2.9%; n = 10), did not differ from those with stable LS BMD (0.1 ± 1.1%; n=5) with regard to baseline body mass index, BMD at any site, or duration of followup, but were significantly older at re-evaluation (46 ± 3 vs 38 ± 7; P = .046), had larger increases in LS BMD during teriparatide treatment and higher cancellous bone remodeling on transiliac biopsy at baseline and completion of teriparatide treatment. Serum bone turnover markers did not differ at baseline or teriparatide completion, but tended to be higher at the re-evaluation timepoint in those with post-teriparatide bone loss.

Conclusions: These findings lead us to conclude that premenopausal women with IOP, particularly those over 40, may require antiresorptive treatment to prevent bone loss after teriparatide.

Trial registration: ClinicalTrials.gov NCT01440803.

Figures

Figure 1.

A, Change in BMD on teriparatide for the 15 women included in this study. B, Change in BMD 2.0 ± 0.6 y after teriparatide cessation. Graphs are shown ± SE. For percent change vs baseline: *, P < .05; **, P < .01; ***, P < .001.

Figure 2.

BMD loss at the LS 2.0 ± 0.6 y after teriparatide cessation was quite variable.

Figure 3.

LS BMD percent change at re-evaluation was inversely associated with bone formation rate (r = −0.61; P = .01) on the baseline biopsy, and even more strongly with bone formation rate (r = −0.73; P = .005) on the 18-mo biopsy.