Effect of Teriparatide on Subsequent Fracture and Bone Mineral Density in 47 Women with Pregnancy- and Lactation-associated Osteoporosis and Vertebral Fractures

Abstract

Introduction Pregnancy- and lactation-associated osteoporosis (PLO) with predominantly vertebral fractures is a rare but severe disease which can occur in the last trimester of pregnancy or postpartum. The aim of the present study was to assess the impact of teriparatide on subsequent fractures and bone mineral density (BMD) in patients with PLO.

Materials and Methods A total of 47 patients with PLO and postpartum spinal fractures (mean: 4 fractures) undergoing treatment with teriparatide were investigated. The data collection period was set between 2006 and 2018. All patients received a subcutaneous injection of 20 µg teriparatide once a day for 24 months as well as individually adapted vitamin D supplementation. After 24 months of treatment, all women received no further treatment and either had regular menstrual cycles or took oral contraceptives. Fractures were confirmed by X-ray or MRI. Changes in BMD from baseline were examined using serial DXA measurements.

Results After 24 months of teriparatide treatment, we could demonstrate an increase in BMD at the lumbar spine, femoral neck and total hip of + 30.1%, + 11.7% and + 12.2% respectively (p < 0.001 for all). At 12 months after cessation of treatment, BMD remained stable compared to the 24-month measurements at the lumbar spine, femoral neck and total hip which showed non-significant changes of + 1.4%, + 2.6% and + 4.1% respectively. Out of the 47 patients with PLO with a mean of 4 existing fractures, 4 patients (7.8%) sustained a subsequent fracture, two after 3 – 5 months of treatment and two at > 6 months of treatment.

Conclusion 24 months of treatment with teriparatide in women with PLO and multiple vertebral fractures significantly increased BMD, predominantly BMD of the spine. As patients were premenopausal, there was no significant decrease in BMD in the following 12 months after cessation of treatment.

Zusammenfassung

Einleitung Schwangerschaftsassoziierte Osteoporose (PLO) mit Wirbelfrakturen ist eine seltene, aber ernste Erkrankung, die im letzten Trimenon oder nach der Geburt auftreten kann. Ziel dieser Studie war es, die Auswirkung von Teriparatid auf nachfolgend auftretende Frakturen sowie die Knochendichte (BMD) bei Patientinnen mit PLO zu evaluieren.

Material und Methoden Untersucht wurden insgesamt 47 Patientinnen mit PLO und postpartalen Wirbelfrakturen (Durchschnitt: 4 Frakturen), die mit Teriparatid behandelt wurden. Die Daten wurden zwischen 2006 und 2018 gesammelt. Alle Patientinnen erhielten einmal täglich eine subkutane Injektion von 20 µg Teriparatid über einen Zeitraum von 24 Monaten sowie eine individuell angepasste Supplementierung mit Vitamin D. Nach 24 Monaten Behandlung wurde die Behandlung ausgesetzt. Alle Frauen hatten entweder regelmäßige Menstruationszyklen oder oder nahmen orale Kontrazeptiva. Das Vorhandensein von Frakturen wurde entweder durch Röntgenuntersuchungen oder MRT bestätigt. Änderungen der Knochendichte-Ausgangswerte wurden mit DXA-Messungen festgestellt.

Ergebnisse Nach 24 Monaten Teriparatid-Behandlung wurde eine Zunahme der Knochendichte im Lendenwirbelbereich, am Schenkelhals und über die gesamte Hüfte in Höhe von + 30,1%, + 11,7% bzw. + 12,2% festgestellt (p < 0,001 für alle Werte). Zwölf Monate nach Einstellung der Behandlung war die Knochendichte stabil verglichen mit den Messungen an der Lendenwirbelsäule, an Schenkelhals und der gesamten Hüfte nach 24 Monaten; es wurden nichtsignifikante Änderungen in Höhe von + 1,4%, + 2,6% bzw. + 4,1% gemessen. Von den insgesamt 47 Patientinnen mit PLO und durchschnittlich 4 Frakturen erlitten 4 Patientinnen (7,8%) nach Beginn der Behandlung 1 Fraktur, davon 2 nach 3 – 5 Monaten Behandlung und 2 nach mehr als 6 Monaten Behandlung.

Schlussfolgerung Eine Behandlung mit Teriparatid über 24 Monate bei Frauen mit PLO und mehreren Wirbelfrakturen führt zu einer signifikanten Zunahme der Knochendichte, vor allem im Bereich der Wirbelsäule. Da alle Patientinnen noch prämenopausal waren, gab es keine signifikante Abnahme der Knochendichte 12 Monate nach Einstellung der Behandlung.

Key words

fracture osteoporosis - teriparatide - pregnancy - lactation

Schlüsselwörter

osteoporotische Frakturen - Teriparatid - Schwangerschaft - Stillzeit

Publikationsverlauf

Eingereicht: 04. November 2021

Angenommen nach Revision: 01. April 2022

Artikel online veröffentlicht:
03. Juni 2022

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