title: Teriparatide increases strength of the peripheral skeleton in premenopausal women with idiopathic osteoporosis: a pilot HR-pQCT study.
abstract: BACKGROUND
  In premenopausal women with idiopathic osteoporosis (IOP), treatment with teriparatide leads to substantial improvement in bone density and quality at central skeletal sites. The effects of teriparatide may differ on cortical and trabecular bone and also at the central and the peripheral skeleton.
  
  
  OBJECTIVE
  The objective of the study was to determine whether teriparatide was associated with improvements in compartmental volumetric bone mineral density (BMD), bone microarchitecture, and estimated bone strength of the distal radius and tibia as assessed by high-resolution peripheral quantitative computed tomography.
  
  
  METHODS
  Premenopausal women (n = 20, age 41 ± 5 y) with IOP (low trauma fractures and/or Z-scores ≤ -2.0) were scanned with high-resolution peripheral quantitative computed tomography at baseline and after 18 months of teriparatide treatment. Cortical and trabecular volumetric BMD and microarchitecture were measured by both standard and advanced techniques, including individual trabecula segmentation, and bone strength was estimated by finite element analysis.
  
  
  METHODS
  The total volumetric BMD and homogeneous bone stiffness were measured.
  
  
  RESULTS
  Trabecular volumetric BMD increased significantly by 2.6% (1.8, 6.2) [median (interquartile range)] at the radius and 2.5% (1.1, 3.6) at the tibia. In addition, trabecular plate bone volume fraction increased by 9.1% (2.1, 17.1) at the radius and 7.6% (1.0, 9.7) at the tibia. Cortical thickness and volumetric density did not change; however, cortical porosity increased at the radius but not at the tibia. Despite these changes, whole-bone stiffness and failure load estimated by finite element analysis increased at both the radius and tibia.
  
  
  CONCLUSIONS
  In premenopausal women with IOP, 18 months of teriparatide was associated with increases in trabecular volumetric BMD, improved trabecular microarchitecture, and estimated bone strength at both the radius and tibia.
authors.affiliation: Division of Endocrinology (K.K.N., A.C., P.Y., E.S.), Department of Medicine, and Department of Pathology (D.W.D.), College of Physicians and Surgeons, Columbia University, New York, New York 10032; Department of Biomedical Engineering (J.W., X.E.G.), Columbia University, New York, New York 10027; and Division of Endocrinology (J.M.L., R.R.R.), Department of Medicine, Creighton University, Omaha, Nebraska 68131.
authors.forename: Kyle K
authors.initials: KK
authors.lastname: Nishiyama
authors.forename: Adi
authors.initials: A
authors.lastname: Cohen
authors.forename: Polly
authors.initials: P
authors.lastname: Young
authors.forename: Ji
authors.initials: J
authors.lastname: Wang
authors.forename: Joan M
authors.initials: JM
authors.lastname: Lappe
authors.forename: X Edward
authors.initials: XE
authors.lastname: Guo
authors.forename: David W
authors.initials: DW
authors.lastname: Dempster
authors.forename: Robert R
authors.initials: RR
authors.lastname: Recker
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Shane
mesh_terms: D000328:Adult; D015519:Bone Density / Q000187:drug effects*; D050071:Bone Density Conservation Agents / Q000008:administration & dosage*; D001842:Bone and Bones / Q000000981:diagnostic imaging / Q000187:drug effects*; D005260:Female; D050723:Fractures, Bone / Q000517:prevention & control; D006801:Humans; D055595:Mechanical Phenomena / Q000187:drug effects; D008875:Middle Aged; D010024:Osteoporosis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology; D010865:Pilot Projects; D017697:Premenopause / Q000187:drug effects; D019379:Teriparatide / Q000008:administration & dosage*; D014057:Tomography, X-Ray Computed / Q000379:methods
chemical_list: D050071:Bone Density Conservation Agents; D019379:Teriparatide