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dc.contributor.authorChiang, Cherie Yingen
dc.contributor.authorZebaze, Roger M Den
dc.contributor.authorGhasem-Zadeh, Alien
dc.contributor.authorIuliano-Burns, Sandraen
dc.contributor.authorHardidge, Andrewen
dc.contributor.authorSeeman, Egoen
dc.identifier.citationBone 2012; 52(1): 360-5en
dc.description.abstractBone remodelling suppressants like the bisphosphonates reduce bone loss and slow progression of structural decay. As remodelling removes damaged bone, when remodelling suppression is protracted, bone quality may be compromised predisposing to microdamage accumulation and atypical femoral fractures. The aim of this study was to determine whether teriparatide therapy assists in fracture healing and improves bone quality in patients with bisphosphonate associated atypical femoral fractures. A prospective study was conducted involving 14 consecutive patients presenting during 2 years with atypical femoral fracture. All patients were offered teriparatide therapy unless contraindicated. Age and sex matched control subjects without fragility fractures or anti-resorptive treatment were recruited. High resolution peripheral micro-computed tomography (HRpQCT) scans of the distal radius and distal tibia were analysed for their cortical bone tissue mineralisation density using new software (StrAx1.0, StrAxCorp, Australia) at baseline and 6 months after teriparatide. Administration of 20 μg of teriparatide subcutaneously daily for 6 months to 5 of the 14 patients was associated with 2-3 fold increase in bone remodelling markers (p=0.01) and fracture healing. At the distal radius, the proportion of less densely mineralised bone increased by 29.5% (p=0.01), and the proportion of older, more densely mineralised bone decreased by 16.2% (p=0.03). Similar observations were made at the distal tibia. Of the nine patients managed conservatively or surgically, seven had poor fracture healing with ongoing pain, one sustained a contralateral atypical fracture and one had fracture union after 1 year. Teriparatide may assist in healing of atypical fractures and restoration of bone quality.en
dc.subject.otherBone Density Conservation Agents.pharmacology.therapeutic useen
dc.subject.otherDiphosphonates.adverse effectsen
dc.subject.otherFemoral Fractures.chemically induceden
dc.subject.otherFracture Healing.drug effectsen
dc.subject.otherProspective Studiesen
dc.subject.otherTeriparatide.pharmacology.therapeutic useen
dc.titleTeriparatide improves bone quality and healing of atypical femoral fractures associated with bisphosphonate therapy.en
dc.typeJournal Articleen
dc.identifier.affiliationDepartment of Endocrinology, Austin Health, University of Melbourne, Melbourne, Australiaen
Appears in Collections:Journal articles

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