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Osteogenesis imperfecta: the impact of therapy with teriparatide
DOI:10.1038/bonekey.2014.121
In this therapeutic clinical trial, 79 adults at high risk of bone fracture because of osteogensis imperfecta (OI), were randomized into two groups and treated with either 20 μg teriparatide (recombinant human parathyroid hormone) or a placebo each day.
The primary endpoints were met; compared with the placebo group, teriparatide treated subjects showed a significant increase in areal bone mineral density at the lumbar spine (+6.1%; P<0.05) and total hip (+2.6%; P<0.001).
They also showed significantly increased vertebral volumetric BMD (+18%; P<0.05) and strength (+15%; P<0.05) while these values in the placebo group fell by 5%. Teriparatide treated participants also showed higher levels of serum procollagen type 1 N-terminal propeptide (P1NP: +135%) and urine collagen N-telopeptide (+64%), both markers of bone remodeling. Increases in P1NP levels were more marked in patients with the mildest form of OI (type I) compared to the more severe forms (types III and IV).
During the period of the study, the number of self-reported in fractures in both groups was very similar.
Editor’s comment: In these patients with OI, teriparatide induced the expected changes in bone turnover markers and gains of BMD, although important differences appeared between type I and III/IV subjects. Whether this treatment will reduce fracture incidence in these patients in the longer term is still unknown.
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