title: Bone Density After Teriparatide Discontinuation in Premenopausal Idiopathic Osteoporosis.
abstract: BACKGROUND
  Without antiresorptive therapy, postmenopausal women lose bone mass after teriparatide (TPTD) discontinuation; estrogen treatment prevents bone loss in this setting. It is not known whether premenopausal women with regular menses lose bone mass after teriparatide discontinuation.
  
  
  OBJECTIVE
  This study aimed to test the hypothesis that normally menstruating premenopausal women with idiopathic osteoporosis (IOP) will maintain teriparatide-associated bone mineral density (BMD) gains after medication cessation.
  
  
  METHODS
  Twenty-one premenopausal IOP women previously enrolled in an open-label pilot study of teriparatide (20 mcg for 18-24 mo), had substantial BMD increases at the lumbar spine (LS; 10.8 ± 8.3%), total hip (TH; 6.2 ± 5.6%), and femoral neck (7.6 ± 3.4%). For this study, BMD was remeasured 2.0 ± 0.6 years after teriparatide cessation.
  
  
  METHODS
  Fifteen women, who had gained 11.1 ± 7.2% at LS and 6.1 ± 6.5% at TH and were premenopausal at teriparatide completion, were followed without antiresorptive treatment.
  
  
  RESULTS
  Two years after completing teriparatide, BMD declined by 4.8 ± 4.3% (P = .0007) at the LS. In contrast, BMD remained stable at the femoral neck (-1.5 ± 4.2%) and TH (-1.1 ± 3.7%). Those who sustained LS bone loss >3% (-7.3 ± 2.9%; n = 10), did not differ from those with stable LS BMD (0.1 ± 1.1%; n=5) with regard to baseline body mass index, BMD at any site, or duration of followup, but were significantly older at re-evaluation (46 ± 3 vs 38 ± 7; P = .046), had larger increases in LS BMD during teriparatide treatment and higher cancellous bone remodeling on transiliac biopsy at baseline and completion of teriparatide treatment. Serum bone turnover markers did not differ at baseline or teriparatide completion, but tended to be higher at the re-evaluation timepoint in those with post-teriparatide bone loss.
  
  
  CONCLUSIONS
  These findings lead us to conclude that premenopausal women with IOP, particularly those over 40, may require antiresorptive treatment to prevent bone loss after teriparatide.
authors.affiliation: Columbia University (A.C., M.K.-K., S.C., M.B., E.S.), New York, New York 10032; Creighton University (R.R.R., J.M.L., J.S.), Omaha, Nebraska 68178; and Helen Hayes Hospital (D.W.D., H.Z.), West Haverstraw, New York 10993.
authors.forename: Adi
authors.initials: A
authors.lastname: Cohen
authors.affiliation: Columbia University (A.C., M.K.-K., S.C., M.B., E.S.), New York, New York 10032; Creighton University (R.R.R., J.M.L., J.S.), Omaha, Nebraska 68178; and Helen Hayes Hospital (D.W.D., H.Z.), West Haverstraw, New York 10993.
authors.forename: Mafo
authors.initials: M
authors.lastname: Kamanda-Kosseh
authors.affiliation: Columbia University (A.C., M.K.-K., S.C., M.B., E.S.), New York, New York 10032; Creighton University (R.R.R., J.M.L., J.S.), Omaha, Nebraska 68178; and Helen Hayes Hospital (D.W.D., H.Z.), West Haverstraw, New York 10993.
authors.forename: Robert R
authors.initials: RR
authors.lastname: Recker
authors.affiliation: Columbia University (A.C., M.K.-K., S.C., M.B., E.S.), New York, New York 10032; Creighton University (R.R.R., J.M.L., J.S.), Omaha, Nebraska 68178; and Helen Hayes Hospital (D.W.D., H.Z.), West Haverstraw, New York 10993.
authors.forename: Joan M
authors.initials: JM
authors.lastname: Lappe
authors.affiliation: Columbia University (A.C., M.K.-K., S.C., M.B., E.S.), New York, New York 10032; Creighton University (R.R.R., J.M.L., J.S.), Omaha, Nebraska 68178; and Helen Hayes Hospital (D.W.D., H.Z.), West Haverstraw, New York 10993.
authors.forename: David W
authors.initials: DW
authors.lastname: Dempster
authors.affiliation: Columbia University (A.C., M.K.-K., S.C., M.B., E.S.), New York, New York 10032; Creighton University (R.R.R., J.M.L., J.S.), Omaha, Nebraska 68178; and Helen Hayes Hospital (D.W.D., H.Z.), West Haverstraw, New York 10993.
authors.forename: Hua
authors.initials: H
authors.lastname: Zhou
authors.affiliation: Columbia University (A.C., M.K.-K., S.C., M.B., E.S.), New York, New York 10032; Creighton University (R.R.R., J.M.L., J.S.), Omaha, Nebraska 68178; and Helen Hayes Hospital (D.W.D., H.Z.), West Haverstraw, New York 10993.
authors.forename: Serge
authors.initials: S
authors.lastname: Cremers
authors.affiliation: Columbia University (A.C., M.K.-K., S.C., M.B., E.S.), New York, New York 10032; Creighton University (R.R.R., J.M.L., J.S.), Omaha, Nebraska 68178; and Helen Hayes Hospital (D.W.D., H.Z.), West Haverstraw, New York 10993.
authors.forename: Mariana
authors.initials: M
authors.lastname: Bucovsky
authors.affiliation: Columbia University (A.C., M.K.-K., S.C., M.B., E.S.), New York, New York 10032; Creighton University (R.R.R., J.M.L., J.S.), Omaha, Nebraska 68178; and Helen Hayes Hospital (D.W.D., H.Z.), West Haverstraw, New York 10993.
authors.forename: Julie
authors.initials: J
authors.lastname: Stubby
authors.affiliation: Columbia University (A.C., M.K.-K., S.C., M.B., E.S.), New York, New York 10032; Creighton University (R.R.R., J.M.L., J.S.), Omaha, Nebraska 68178; and Helen Hayes Hospital (D.W.D., H.Z.), West Haverstraw, New York 10993.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Shane
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D015519:Bone Density / Q000187:drug effects*; D050071:Bone Density Conservation Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001846:Bone Development / Q000187:drug effects; D005260:Female; D006801:Humans; D008875:Middle Aged; D008903:Minerals / Q000378:metabolism; D015663:Osteoporosis, Postmenopausal / Q000188:drug therapy* / Q000473:pathology*; D010865:Pilot Projects; D017697:Premenopause; D013131:Spine / Q000473:pathology; D019379:Teriparatide / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D015415:Biomarkers; D050071:Bone Density Conservation Agents; D008903:Minerals; D019379:Teriparatide