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Title: Teriparatide improves bone quality and healing of atypical femoral fractures associated with bisphosphonate therapy.
Austin Authors: Chiang, Cherie Ying;Zebaze, Roger M D;Ghasem-Zadeh, Ali ;Iuliano-Burns, Sandra ;Hardidge, Andrew;Seeman, Ego 
Affiliation: Department of Endocrinology, Austin Health, University of Melbourne, Melbourne, Australia
Issue Date: 13-Oct-2012
Publication information: Bone 2012; 52(1): 360-5
Abstract: Bone 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.
Gov't Doc #: 23072919
DOI: 10.1016/j.bone.2012.10.006
Journal: Bone
Type: Journal Article
Subjects: Aged
Bone Density Conservation Agents.pharmacology.therapeutic use
Diphosphonates.adverse effects
Femoral Fractures.chemically induced
Fracture Healing.drug effects
Prospective Studies
Teriparatide.pharmacology.therapeutic use
Appears in Collections:Journal articles

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