Use of teriparatide off-label: our experience and review of literature

Ciurlia, Emanuele; Leali, P. Tranquilli; Doria, Carlo

doi:10.11138/ccmbm/2017.14.1.028

Cited by 13 publications

(11 citation statements)

References 48 publications

(30 reference statements)

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“…Although bisphosphonates appear to increase BMD in adults with OI (21,22), they reduce bone remodeling and bone formation, actions that may be problematic in the presence of underlying defects in bone formation and osteoblastic function. In contrast, in our study of teriparatide therapy, there was an anabolic pattern of change in remodeling markers that mimicked those observed in previous studies of teriparatide therapy in osteoporosis (23,24). Moreover, the teriparatideinduced improvements in BMD in the type I OI patients were similar to those seen in osteoporosis (25) and similar to the responses recently reported in a small clinical experiment with teriparatide therapy in type I OI (26).…”

Section: Discussioncontrasting

confidence: 53%

Efficacy of teriparatide vs neridronate in adults with osteogenesis imperfecta type I: a prospective randomized international clinical study

Balsano²,

Maestretti

et al. 2017

ccmbm

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SummaryOsteogenesis imperfecta (OI) is an hereditary disease characterized by low bone mass, increased bone fragility, short stature, and skeletal deformities, few treatment options are currently available. Neridronate is an aminobisphosphonate, licensed in Italy for the treatment of OI and Paget's disease of bone. A characteristic property of neridronate is that it can be administered both intravenously and intramuscularly, providing an useful system for administration in homecare. Neridronate appears to increase Bone Mineral Density (BMD) in adults with OI and reduces bone resorption by inhibition of osteoclastic activity. Teriparatide (recombinant 1-34 N terminal sequence of human parathyroid hormone) is the first anabolic agent approved for the treatment of patients with osteoporosis and has been reported to increase bone formation by stimulating osteoblast differentiation, osteoblast function, and survival. The results of this study showed a promising role of teriparatide in the therapy of OI type I.

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Section: Discussioncontrasting

confidence: 53%

Efficacy of teriparatide vs neridronate in adults with osteogenesis imperfecta type I: a prospective randomized international clinical study

Balsano²,

Maestretti

et al. 2017

ccmbm

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“…Bisphosphonates are the cornerstone for the treatment of osteoporosis [5] and are commonly prescribed for its treatment, both in women and men [6]. More recently, other drugs (i.e., teriparatide and denosumab) are often prescribed and showed a safety profile [7], even when prescribed for therapy of non-unions [8]. However, a surgical approach sometimes necessary, in particular, in the case of vertebral compression fractures [9].…”

Section: Introductionmentioning

confidence: 99%

Thyroid Hormone Diseases and Osteoporosis

Delitala

Scuteri

Doria

2020

JCM

126

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Thyroid hormones are essential for normal skeletal development and normal bone metabolism in adults but can have detrimental effects on bone structures in states of thyroid dysfunction. Untreated severe hyperthyroidism influences the degree of bone mass and increases the probability of high bone turnover osteoporosis. Subclinical hyperthyroidism, defined as low thyrotropin (TSH) and free hormones within the reference range, is a subtler disease, often asymptomatic, and the diagnosis is incidentally made during screening exams. However, more recent data suggest that this clinical condition may affect bone metabolism resulting in decreased bone mineral density (BMD) and increased risk of fracture, particularly in postmenopausal women. The main causes of exogenous subclinical hyperthyroidism are inappropriate replacement dose of thyroxin and TSH suppressive L-thyroxine doses in the therapy of benign thyroid nodules and thyroid carcinoma. Available data similarly suggest that a long-term TSH suppressive dose of thyroxin may decrease BMD and may induce an increased risk of fracture. These effects are particularly observed in postmenopausal women but are less evident in premenopausal women. Overt hypothyroidism is known to lower bone turnover by reducing both osteoclastic bone resorption and osteoblastic activity. These changes in bone metabolism would result in an increase in bone mineralization. At the moment, there are no clear data that demonstrate any relationship between BMD in adults and hypothyroidism. Despite these clinical evidences, the cellular and molecular actions of thyroid hormones on bone structures are not complete clear.

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“…Bone stimulators are used in the able-bodied population. (48) Anabolics such as teriparatide have been used off-label to treat fracture nonunion in the ablebodied population; (49) however, there was no use of these in this SCID series. This may reflect the fact that hypercalcemia and hypercalciuria, both potential side effects of teriparatide, may be of greater concern in persons with a SCID, although this is a greater concern immediately after injury, rather than with chronic SCID.…”

Section: Discussionmentioning

confidence: 98%

Risk Factors and Consequences of Lower Extremity Fracture Nonunions in Veterans With Spinal Cord Injury

et al. 2022

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We used Veterans Health Administration (VHA) national administrative data files to identify a cohort (fiscal years 2005-2014) of veterans with spinal cord injuries and disorders (SCID) to determine risk factors for and consequences of lower extremity fracture nonunions. Odds ratios (OR) for fracture nonunion were computed using multivariable-adjusted logistic regression models. We identified three risk factors for nonunion: (i) older age (OR = 2.29; 95% confidence interval [CI] 1.21-4.33), (ii) longer duration of SCID (OR = 1.02; 95% CI 1.00-1.04), and (iii) fracture site (distal femur), with OR (comparison distal femur) including distal tibia/fibula (OR = 0.14; 95% CI 0.09-0.24), proximal tibia/fibula (OR = 0.19; 95% CI 0.09-0.38), proximal femur (OR = 0.10; 95% CI 0.04-0.21), and hip (OR = 0.13; 95% CI 0.07-0.26). Nonunions resulted in multiple complications, with upwards of 1/3 developing a pressure injury, 13% osteomyelitis, and almost 25% requiring a subsequent amputation. Our data have identified a high-risk population for fracture nonunion of older veterans with a long duration of SCID who sustain a distal femur fracture. In view of the serious complications of these nonunions, targeted interventions in these high-risk individuals who have any signs of delayed union should be considered.

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Use of teriparatide off-label: our experience and review of literature

Cited by 13 publications

References 48 publications

Efficacy of teriparatide vs neridronate in adults with osteogenesis imperfecta type I: a prospective randomized international clinical study

Efficacy of teriparatide vs neridronate in adults with osteogenesis imperfecta type I: a prospective randomized international clinical study

Thyroid Hormone Diseases and Osteoporosis

Risk Factors and Consequences of Lower Extremity Fracture Nonunions in Veterans With Spinal Cord Injury

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