Bone Abstracts

Background: Treatment of osteoporosis with bisphosphonates may result in severe suppression of bone turnover leading to adynamic bone disease. Teriparatide is now commonly used as an anabolic agent in adults with osteoporosis, and has the potential to reverse the effect of bisphosphonates. However its use in pediatrics is restricted to those with closed growth plates and information regarding its effect in this age group limited.

Objective: To study the effect and safety of teriparatide in post-pubertal teenagers and very young adults who previously were treated with bisphosphonates for their osteoporosis and developed adynamic bone disease.

Patients and methods: Seven post-pubertal patients with osteoporosis who were previously treated with bisphosphonates and developed evidence of adynamic bone disease manifested by very suppressed bone turnover markers, were treated with teriparatide 20 μ per day for 2 years. The incidence of fragile fractures in the 2 preceding years and during the treatment period were compared, as were spinal DXA, serum creatinine, Ca, P, PTH, bone specific alkaline phosphatase (BSAP), osteocalcin and urine NTX.

Results: Patients age ranged between 16 and 23 years, mean±S.D. 18.7±2.4, 5 were female. In all patients pre-treatment radiographs showed closure of growth plates. With treatment the incidence of fragile fractures decreased from 0.21 to 0.00 year (NS). Spinal z-scores improved from −4.49±1.20 to −3.71±0.91 (P<0.005). Serum creatine, Ca, P and did not change significantly, staying within normal range in all, besides one patient who developed transient mild hypercalcemia at 11.2 mg/dl. BSAP increased from 22.5±7.7 to 43.5±17.1 μ/l (P<0.02), osteocalcin from 17.8±3.3 to 57.1±30.9 ng/ml (P<0.05) and urine NTX from 59.4±18.0 to 217.5±113.3 nmol/mmol creatinine (P<0.05). No patient developed adverse effects requiring discontinuation of the medicine.

Conclusion: In this small sample of patients teriparatide proved itself to be safe and effective treatment in reversing adynamic bone disease and improving its condition. Further studies are warranted on the use of this anabolic agent in the pediatric age group.

Disclosure: The authors declared no competing interests.