In a recent paper, Watts and colleagues examined the clinical significance in non-responders of bone mineral density (BMD) measured at the femoral neck after 12-month treatment with teriparatide, a parathyroid hormone analogue, compared to placebo in terms of vertebral fracture risk reduction . A BMD change from baseline of > 4% was considered to be clinically significant. Women on teriparatide who lost femoral neck BMD still had significant reductions in vertebral fracture risk compared with placebo (relative risk 0.11; 95% confidence interval, 0.03–0.45). Vertebral fracture risk reduction with teriparatide compared with placebo was similar across categories of femoral neck BMD change from baseline at 12 months (loss > 4%, ‘loss’ 0–4%, ‘gain’ 0–4%, or gain > 4%) (interaction, p = 0.40). Irrespective of femoral neck BMD loss or gain, it was concluded that loss of femoral neck BMD at 12 months in postmenopausal women with osteoporosis treated with teriparatide is nevertheless consistent with a good treatment response in terms of vertebral fracture risk reduction.
Tobie de Villiers
Consultant Gynaecologist, Panorama MediClinic and University of Stellenbosch, Cape Town, South Africa
Watts N, Miller PD, Kohlmeier LA, et al. Vertebral fracture risk is reduced in women who lose femoral neck bone mineral density with teriparatide treatment. J Bone Min Res 2008 Dec 29. [Epub ahead of print].
Sebba AI. Significance of a decline in bone mineral density while receiving oral bisphosphonate therapy. Clin Ther 2008;30:443-52. Published March, 2008.