title: Postmenopausal women with osteoporosis: experience when treated with teriparatide in clinical practice.
abstract: OBJECTIVE
  To observe and compare back pain and health-related quality of life (HRQoL) in postmenopausal women with a prior unsatisfactory response to antiresorptive therapy, treated with teriparatide (TPTD) or alternative treatments in normal clinical practice.
  
  
  METHODS
  Prospective, observational, multicentre, 24-month study of postmenopausal women with osteoporosis. A back pain and HRQoL questionnaire (European Quality of Life Questionnaire, EQ-5D) including visual analogue scale (VAS) was completed at each visit.
  
  
  RESULTS
  A total of 153 patients were enrolled, 105 patients started TPTD treatment during the study (TPTD cohort) and 48 patients did not take TPTD treatment at any time during the study (non-TPTD cohort). Four patients did not meet the inclusion criteria for the study. Of the patients in the non-TPTD cohort, 31 (68.9%) took antiresorptives during the study. The patients selected by the investigator for teriparatide treatment were distinctly different from those not selected. At baseline, the mean back pain VAS was greater in the TPTD than the non-TPTD cohort, 64  mm and 42 mm, respectively (p < 0.001). During the study, compared with baseline, the mean back pain VAS decreased in the TPTD cohort at all visits (p < 0.001). In the non-TPTD cohort, a transitory decrease in the mean after 12 months was observed (-10 mm, p = 0.023) only. After 24 months, the mean back pain VAS improved in the TPTD cohort (-36 mm, p < 0.001) while no change was observed in the non-TPTD cohort (-4 mm, p = 0.467). At baseline, the mean EQ-VAS was lower in the TPTD than in the non-TPTD cohort, 40.8 and 55.2, respectively (p < 0.001). After 24 months, EQ-VAS improved in both cohorts (TPTD 34, p < 0.001 and non-TPTD 9, p = 0.026).
  
  
  CONCLUSIONS
  TPTD-treated patients had more back pain and lower HRQoL at baseline. In the TPTD cohort the mean value was consistently and significantly improved in back pain and quality of life. In the non-TPTD cohort, the mean improvement in back pain and QoL was inconsistent possibly due to the initially higher QoL and lower back pain leaving less room for improvement. These results should be interpreted in the context of limitations related to a non-randomised observational study.
authors.affiliation: Bone and Mineral Metabolism Unit, Rambam Health Care Campus, Technion Faculty of Medicine, Haifa, Israel.
authors.forename: Sophia
authors.initials: S
authors.lastname: Ish-Shalom
authors.forename: Constantin
authors.initials: C
authors.lastname: Dumitrache
authors.forename: Timour Fikry
authors.initials: TF
authors.lastname: El-Husseini
authors.forename: Azza
authors.initials: A
authors.lastname: Hussein
authors.forename: Clare
authors.initials: C
authors.lastname: Barker
authors.forename: Imre
authors.initials: I
authors.lastname: Pavo
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D001416:Back Pain / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D010147:Pain Measurement; D017698:Postmenopause / Q000187:drug effects; D011364:Professional Practice / Q000706:statistics & numerical data; D011788:Quality of Life; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D019379:Teriparatide / Q000627:therapeutic use*
chemical_list: D050071:Bone Density Conservation Agents; D019379:Teriparatide