title: A fracture does not adversely affect bone mineral density responses after teriparatide treatment.
abstract: BACKGROUND
  Fracture leads to local and systemic catabolic physiologic changes. As teriparatide is an agent used to treat osteoporosis in patients with fragility fractures, it is unclear whether teriparatide treatment alters bone mineral density (BMD) and bone markers when given to patients with fractures.
  
  
  OBJECTIVE
  We asked whether BMD and bone marker responses would be blunted in patients with fractures placed on teriparatide after fracture compared with patients without fractures on teriparatide.
  
  
  METHODS
  We retrospectively collected data from 141 patients treated with teriparatide for osteoporosis. Seventy-seven patients received teriparatide after fractures (fracture group), whereas 64 were treated for other indications (nonfracture group). We determined BMD at the lumbar spine and at the proximal femur before and 12 and 24 months posttreatment. Bone markers (urine N-telopeptide [urine NTX], bone-specific alkaline phosphatase [BALP]) were measured at baseline and 3, 12, and 24 months posttreatment.
  
  
  RESULTS
  Mean lumbar spine and hip BMDs at last followup increased from baseline with no differences between groups to approximately 9% and 4% at 24 months, respectively. Both bone markers increased from baseline in the nonfracture group, peaking at 12 months. For the fracture group, only urine NTX increased at 3 and 12 months posttreatment. Although the peak levels of both bone markers in the nonfracture group were greater, there was no difference between the two groups.
  
  
  CONCLUSIONS
  Fracture does not have a negative effect on the BMD and bone marker responses to teriparatide treatment. Clinicians should anticipate comparable BMD responses when treating patients with teriparatide for osteoporotic fractures and for other indications.
  
  
  METHODS
  Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA. uaasis@gmail.com
authors.forename: Aasis
authors.initials: A
authors.lastname: Unnanuntana
authors.forename: Quang V
authors.initials: QV
authors.lastname: Ton
authors.forename: John P
authors.initials: JP
authors.lastname: Kleimeyer
authors.forename: Joseph T
authors.initials: JT
authors.lastname: Nguyen
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Lane
mesh_terms: D000368:Aged; D015992:Body Mass Index; D015519:Bone Density / Q000187:drug effects* / Q000502:physiology; D050071:Bone Density Conservation Agents / Q000494:pharmacology* / Q000627:therapeutic use; D024042:Collagen Type I / Q000652:urine; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000188:drug therapy; D010455:Peptides / Q000652:urine; D012189:Retrospective Studies; D019379:Teriparatide / Q000494:pharmacology* / Q000627:therapeutic use
chemical_list: D050071:Bone Density Conservation Agents; D024042:Collagen Type I; D010455:Peptides; C052929:collagen type I trimeric cross-linked peptide; D019379:Teriparatide