Jenny Zhao MD, PRESENTER: Nothing to Disclose

Abstract: HTML Purpose: Teriparatide injection (rDNA origin) [rhPTH(1-34)] significantly increased areal bone mineral density at the lumbar spine and proximal femur, had no effect or decreased mineral density at the distal radius, and decreased both vertebral and nonvertebral fractures in postmenopausal women with osteoporosis. We studied the ability of teriparatide to improve both cancellous and cortical bone in a subset of women enrolled in a multi-center, double-blind, randomized and placebo controlled study of postmenopausal women with osteoporosis following a mean treatment time of 19 months. This is the first report of a biopsy study having a sufficient number of paired biopsy samples to provide quantitative structural data. Methods and Materials: Fifty-one paired iliac crest bone biopsies [placebo (n=19), 20 mg teriparatide (n=18) and 40 mg teriparatide (n=14)] were analyzed using both three-dimensional (3D) micro CT and 2D histomorphometry. The 3D cancellous and cortical structural parameters were measured directly, without stereological model assumptions as in 2D histomorphometry, using a Scanco µCT with isotropic resolution of 17 µ. All specimens were blindly measured. Data for both teriparatide treatment groups were pooled for analysis. Results: By 3D cancellous and cortical bone structural analyses, teriparatide significantly decreased the cancellous structure model index (median percent change: teriparatide, -12%; placebo, 7%; p=0.025), increased cancellous connectivity density (teriparatide, 19%; placebo, -14%; p=0.034) and increased cortical thickness (teriparatide, 22%; placebo, 3%; p=0.012). By 2D histomorphometric analyses, teriparatide significantly increased cancellous bone volume (teriparatide, 14%; placebo, -24%; p=0.001), and reduced marrow star volume (teriparatide, -16%; placebo, 112%; p=0.004). Teriparatide administration was not associated with osteomalacia or woven bone, and there were no significant changes in mineral appositional rate or wall thickness. Conclusion: These data show that teriparatide treatment of postmenopausal women with osteoporosis significantly increased cancellous bone volume and connectivity, improved trabecular morphology with a shift toward a more plate-like structure, and increased cortical bone thickness. These changes in cancellous and cortical bone morphology should improve biomechanical competence and are consistent with the substantially reduced incidences of vertebral and nonvertebral fractures during administration of teriparatide.     (J.Z. received a grant from Eli Lilly and Company.)

Zhao MD, J, Teriparatide [Recombinant Human Parathyroid Hormone (1-34)] Improves both Cortical and Trabecular Microstructure of Postmenopausal Osteoporotic Women in a Multicenter, Double-Blind, Randomized and Placebo Controlled.  Radiological Society of North America 2003 Scientific Assembly and Annual Meeting, November 30 - December 5, 2003 ,Chicago IL. http://archive.rsna.org/2003/3105569.html