Safety and efficacy of teriparatide treatment for severe osteoporosis in patients with Duchenne muscular dystrophy

Nasomyont, N.; Keefe, C.; Tian, C.; Hornung, L.; Khoury, J.; Tilden, J. C.; Hochwalt, P.; Jackson, E.; Rybalsky, I.; Wong, B. L.; Rutter, M. M.

Affiliations

¹Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, Cincinnati, USA

²Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, USA

³Diabetes and Endocrinology, Helen DeVos Children’s Hospital, Grand Rapids, USA

⁴Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, USA

⁵Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, USA

⁶Yale University, New Haven, USA

⁷Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, USA

⁸Division of Nephrology, Cincinnati Children’s Hospital Medical Center, Cincinnati, USA

⁹Department of Pediatrics, University of Massachusetts Memorial Children’s Medical Center, University of Massachusetts Medical School, Worcester, USA

Abstract and keywords

Summary: Osteoporosis is a major concern in patients with Duchenne muscular dystrophy. In this novel study of teriparatide treatment in 6 patients with severe osteoporosis, bone health (fractures, vertebral morphometry, and DXA) remained stable, with no adverse events. These findings will help inform future osteoporosis research in this challenging population.

Introduction: Despite standard therapy with vitamin D and bisphosphonates (BP), many patients with Duchenne muscular dystrophy (DMD) continue to sustain fragility fractures due to long-term glucocorticoid treatment and limited mobility. We aimed to evaluate the safety and efficacy of teriparatide for the treatment of severe osteoporosis in adolescent and young adult patients with DMD.

Methods: We prospectively treated 6 patients with DMD who had severe osteoporosis with teriparatide 20 mcg subcutaneously daily for 1–2 years. Inclusion criteria were long-term glucocorticoid therapy, and severe osteoporosis despite treatment with BP, or intolerance to BP. We examined long bone and vertebral fracture outcomes, including vertebral morphometry measures, bone mineral density and content, bone formation markers, safety indices, and adverse events.

Results: The mean age at teriparatide start was 17.9 years (range 13.9–22.1 years). All 6 patients were on daily glucocorticoids (mean ± SD; duration 10.9 ± 2.5 years) and 5 were non-ambulatory. Five patients had been treated with BP for 7.9 ± 4.2 years. All had vertebral and a history of long bone fragility fractures at baseline. Vertebral heights and Genant fracture grading remained stable. Long bone fracture rate appeared to decrease (from 0.84/year to 0.09/year); one patient sustained a long bone fracture at 6 months of treatment. Trajectories for change in bone mineral density and content were not different post- vs. pre-teriparatide. Procollagen type 1 amino-terminal propeptide (P1NP) increased, while laboratory safety indices remained stable and non-concerning. No adverse events were observed.

Conclusion: In six patients with DMD treated with teriparatide for severe osteoporosis, we observed stable bone health and modest increases in P1NP, without safety concerns. Further studies are needed to better understand teriparatide efficacy for treatment of osteoporosis in patients with DMD.

Keywords: Children; Duchenne muscular dystrophy; Fracture; Osteoporosis; Parathyroid hormone; Teriparatide

Links

DOI: 10.1007/s00198-020-05549-z

PubMed: 32676823

WoS: 000549372100001

History

Received: 2020-04-02

Accepted: 2020-07-08

Online: 2020-07-17

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