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Teriparatide Treatment in Patients with Pregnancy- and Lactation-Associated Osteoporosis

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Abstract

Pregnancy- and lactation-associated osteoporosis (PLO) is a rare disease, presenting in most cases with severe back pain due to low energy vertebral fractures (VFs). Our purpose was to assess the effect of teriparatide (TPTD) vs. conventional management on areal bone mineral density (aBMD) and trabecular bone score (TBS) in patients with PLO. A multicenter retrospective cohort study concerning premenopausal women with PLO. Nineteen women were treated with TPTD (20 μg/day) (group A) plus calcium and vitamin D and eight women with calcium and vitamin D only (group B) for up to 24 months. The primary end-point was between group differences in lumbar spine (LS) and total hip (TH) aBMD, and TBS at 12 and 24 months. Patients in group A had sustained a median of 4.0 VFs (3–9) vs. 2.5 VFs (1–10) in group B (p = 0.02). At 12 months, patients on TPTD vs. controls achieved a mean aBMD increase of 20.9  ±  11.9% vs. 6.2  ±  4.8% at the LS (p < 0.001), 10.0  ±  11.6% vs. 5.8  ±  2.8% at the TH (p = 0.43), and 6.7  ±  6.9% vs. 0.9  ±  3.7% in TBS (p = 0.09), respectively. At 24 months, seven patients on TPTD and six controls achieved a mean LS aBMD increase of 32.9  ±  13.4% vs. 12.2  ±  4.2% (p = 0.001). P1NP levels during the first month of TPTD treatment were positively correlated with the 1-year LS aBMD change (r = 0.68, p = 0.03). No new clinical fractures occurred while on-treatment. In patients with PLO, TPTD treatment resulted in significantly greater increases in LS aBMD compared with calcium and vitamin D supplementation at 12 and 24 months.

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Acknowledgements

The authors would like to thank George Kiniklis for performing the DXA, TBS and VFA measurements in KAT General Hospital and Antonios Galanos, PhD for his assistance in statistical analysis.

Funding

There was no funding.

Author information

Author notes

  1. Ioannis K. Triantafyllopoulos, Maria P. Yavropoulou and Athanasios D. Anastasilakis have contributed equally to this study.

Authors and Affiliations

  1. Laboratory for the Research of Musculoskeletal System “Th. Garofalidis”, School of Medicine, National and Kapodistrian University of Athens, KAT General Hospital, Athinas 10th Str. 14561, Athens, Greece

    Kalliopi Lampropoulou-Adamidou, Georgios Trovas, Ioannis K. Triantafyllopoulos & Symeon Tournis

  2. 5th Orthopaedic Department, HYGEIA Hospital, Athens, Greece

    Ioannis K. Triantafyllopoulos

  3. Endocrinology Unit, 1st Department of Propaedeutic and Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece

    Maria P. Yavropoulou

  4. Department of Endocrinology, 424 General Military Hospital, Thessaloniki, Greece

    Athanasios D. Anastasilakis & Konstantinos A. Toulis

  5. Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Panagiotis Anagnostis

  6. Biochemistry Department, KAT General Hospital, Athens, Greece

    Konstantinos Makris

  7. Rheumatology Department, KAT General Hospital, Athens, Greece

    Sousana Gazi

  8. Department of Computed Tomography, Asklepeion Voulas Hospital, Athens, Greece

    Alexia Balanika

Authors
  1. Kalliopi Lampropoulou-Adamidou
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  2. Georgios Trovas
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  3. Ioannis K. Triantafyllopoulos
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  4. Maria P. Yavropoulou
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  5. Athanasios D. Anastasilakis
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  6. Panagiotis Anagnostis
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  7. Konstantinos A. Toulis
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  8. Konstantinos Makris
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  9. Sousana Gazi
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  11. Symeon Tournis
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Contributions

All listed authors contributed to the conception, design, acquisition, analysis and interpretation of the data and/or writing of the manuscript and they all approved the version of the manuscript submitted to “Calcified Tissue International”.

Corresponding author

Correspondence to Symeon Tournis.

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Disclosure

KLA has received lecture fees from Amgen, GT has received lecture and/or advisory board fees from Amgen, Eli Lilly, ELPEN, ITF Hellas, VIANEX, LIBYTEC, Galenica, Merck Biopharma, MPY has received lecture fees from Galenica, Shire, and Eli Lilly, ADA has received lecture fees from Amgen, Eli Lilly, ELPEN, ITF Hellas, and VIANEX; ST has received lecture and/or advisory board fees from Amgen, Eli Lilly, VIANEX, ITF Hellas, LIBYTEC, Merck Biopharma Greece, Galenica, and Shire. IIT, PA, KAT, MK, SG and AB have nothing to disclose.

Ethical approval

The study was approved by the ethics committee of KAT General Hospital. All procedures were conducted according to the recommendations of Good Clinical Practice and all other applicable local regulatory and ethical requirements and the Declaration of Helsinki (revised edition, Tokyo 2004).

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Written informed consent was obtained from all patients.

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Lampropoulou-Adamidou, K., Trovas, G., Triantafyllopoulos, I.K. et al. Teriparatide Treatment in Patients with Pregnancy- and Lactation-Associated Osteoporosis. Calcif Tissue Int 109, 554–562 (2021). https://doi.org/10.1007/s00223-021-00871-y

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  • DOI: https://doi.org/10.1007/s00223-021-00871-y

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