Predictors of teriparatide treatment failure in patients with low bone mass.
BACKGROUND
While teriparatide is the only skeletal anabolic agent approved in the United States, treatment failure is a major concern which complicates its clinical utility. We sought to identify factors that predict response failure in patients with low bone mass.


METHODS
We performed a retrospective study of adults with osteopenia or osteoporosis (T-scores < - 1.0 and - 2.5 SD below normal, respectively, at the total hip or lumbar spine) treated with teriparatide at the Mayo Clinic (Rochester, Minnesota) between November 2002-December 2012. Trained study investigators blinded to patient outcomes collected electronic medical record data. Potential response failure predictors were identified using univariate analysis. Multivariable logistic regression modeling was used to identify independent predictors of treatment failure based on either osteoporotic fragility fracture or BMD response.


RESULTS
During the 10-year period, 494 patients received teriparatide treatment and met eligibility criteria. Thirty-five patients had osteoporotic fractures, while 172 did not achieve a ≥ 3% BMD increase. Among predictors as defined by BMD change, both prior bisphosphonate treatment [odds ratio (95% confidence interval), 1.50 (1.01-2.24)] and vitamin D therapy [1.50 (1.01-2.22)] were significantly (P < 0.05) associated with teriparatide treatment failure. By contrast, no predictors were associated with treatment failure when fracture was the endpoint.


CONCLUSIONS
These data suggest that prior bisphosphonate or vitamin D exposure may predict response failure to teriparatide therapy. Although these findings may, in part, reflect increased severity or longer duration of disease, this knowledge should help guide clinicians and patients when therapy choices are made.
Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN, United States; Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, United States.
Tarig
T
Elraiyah
Wichita Falls Family Practice Residency Program (WFFRP), North Central Texas Medical Foundation, Wichita Falls, TX, United States.
Adil H
AH
Ahmed
Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, United States; Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, United States.
Zhen
Z
Wang
Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, United States.
Joshua N
JN
Farr
Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, United States; Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, United States; Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, MN, United States.
Mohammad H
MH
Murad
Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, United States.
Matthew T
MT
Drake
Anabolic skeletal therapy; Bone mineral density; Osteoporosis; Osteoporotic fracture; Response failure