Teriparatide increases bone formation and bone mineral density in adult women with anorexia nervosa.
BACKGROUND
Anorexia nervosa (AN), a prevalent psychiatric disorder predominantly affecting women, is characterized by self-induced starvation and low body weight. Increased clinical fractures are common, and most women have low bone mineral density (BMD). Previously investigated treatments have led to no or modest increases in BMD in AN.


OBJECTIVE
Our objective was to investigate the effect of teriparatide (TPT; human PTH[1-34]), an anabolic agent, on low bone mass in women with AN.


METHODS
This randomized, placebo-controlled trial at a clinical research center included 21 women with AN: 10 (mean age ± SEM, 47 ± 2.7 years) treated with TPT and 11 (47.1 ± 2.3 years) treated with placebo.


METHODS
TPT (20 μg s.c.) or placebo was administered for 6 months.


METHODS
Our primary outcome measure was change in BMD of the spine and hip by dual-energy x-ray absorptiometry. Secondary outcome measures included changes in serum N-terminal propeptide of type 1 procollagen (P1NP), C-terminal collagen cross-links, sclerostin, and IGF-1 levels.


RESULTS
At 6 months, spine BMD increased significantly more with TPT (posteroanterior spine, 6.0% ± 1.4%; lateral spine, 10.5% ± 2.5%) compared with placebo (posteroanterior spine, 0.2% ± 0.7%, P < .01; lateral spine, -0.6% ± 1.0%; P < .01). The results remained significant after controlling for baseline body mass index, P1NP, and IGF-1. Changes in femoral neck (P = .4) and total hip (P = 0.8) BMD were comparable in both groups, as were changes in weight. Serum P1NP levels increased after 3 months of TPT treatment and remained at this higher level at 6 months, whereas P1NP levels were unchanged in the placebo group (P = .02). TPT was well-tolerated by all subjects.


CONCLUSIONS
This study demonstrates that TPT administration increases spine BMD substantially after only 6 months of therapy in women with AN.
Neuroendocrine Unit (P.K.F., I.S.W., K.K.M., M.M., A.K.), Biostatistics Center (H.L.), and Endocrine Unit (J.S.F.), Massachusetts General Hospital, Boston, Massachusetts 02114; Center for Advanced Orthopaedic Studies (M.L.B.), Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215; and Harvard Medical School (P.K.F., K.K.M., D.B.H., M.M., H.L., J.S.F., M.L.B., A.K.), Boston, Massachusetts 02115.
Pouneh K
PK
Fazeli
Irene S
IS
Wang
Karen K
KK
Miller
David B
DB
Herzog
Madhusmita
M
Misra
Hang
H
Lee
Joel S
JS
Finkelstein
Mary L
ML
Bouxsein
Anne
A
Klibanski
D000328:Adult; D000856:Anorexia Nervosa / Q000097:blood / Q000188:drug therapy / Q000503:physiopathology*; D015415:Biomarkers / Q000097:blood; D015519:Bone Density / Q000187:drug effects*; D050071:Bone Density Conservation Agents / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000032:analysis; D008875:Middle Aged; D010012:Osteogenesis / Q000187:drug effects*; D011506:Proteins / Q000032:analysis; D019379:Teriparatide / Q000008:administration & dosage*
D015415:Biomarkers; D050071:Bone Density Conservation Agents; D011506:Proteins; C013247:sclerotin; D019379:Teriparatide; D007334:Insulin-Like Growth Factor I