Changes in trabecular and cortical bone microarchitecture at peripheral sites associated with 18 months of teriparatide therapy in postmenopausal women with osteoporosis

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Macdonald, H. M.^1,2; Nishiyama, K. K.^1,2; Hanley, D. A.³; Boyd, S. K.^1,2

Changes in trabecular and cortical bone microarchitecture at peripheral sites associated with 18 months of teriparatide therapy in postmenopausal women with osteoporosis

Osteoporos Int. January 2011;22(1):357-362

©2010 International Osteoporosis Foundation and National Osteoporosis Foundation

Affiliations

¹Department of Mechanical and Manufacturing Engineering, Schulich School of Engineering, University of Calgary, 2500 University Drive, N.W., Calgary, AB T2N 1N4, Canada

²Roger Jackson Centre for Health and Wellness, University of Calgary, Calgary, AB, Canada

³Department of Medicine, University of Calgary, Calgary, AB, Canada
Abstract and keywords

Summary: We used high-resolution peripheral quantitative computed tomography (HR-pQCT) to monitor changes in bone microarchitecture and strength at the distal radius and tibia associated with 18 months of teriparatide therapy in postmenopausal women with osteoporosis. Despite treatment-associated declines in total and cortical BMD, trabecular thinning and reduced trabecular bone volume, bone strength did not change significantly from baseline.

Introduction: Teriparatide is an established anabolic therapy for osteoporosis; however, treatment effects at the distal radius are unclear. Therefore, we aimed to monitor changes in bone microarchitecture and estimated strength at the distal radius and tibia in osteoporotic postmenopausal women.

Methods: We used high-resolution peripheral quantitative computed tomography (Scanco Medical, Switzerland) to perform a standard three-dimensional morphological analysis of the distal radius and tibia in 11 osteoporotic postmenopausal women (mean age, 68.7 ± 12.7 years) at baseline, 6, 12, and 18 months after initiation of 20 μg/day of teriparatide. Ten of the women received bisphosphonate therapy prior to starting on teriparatide. In addition to the standard analysis, we quantified cortical bone mineral density (BMD), porosity, and thickness using an automated segmentation procedure and estimated bone strength (ultimate stress) using finite element analysis.

Results: After 18 months, we observed a decrease in total BMD (p = 0.03) at the distal radius and a decrease in cortical BMD at the distal radius (p = 0.05) and tibia (p = 0.01). The declines in cortical BMD were associated with trends for increased cortical porosity at both sites. At the distal radius, 18 months of teriparatide treatment was also associated with trabecular thinning (p = 0.009) and reduced trabecular bone volume ratio (p = 0.08). We observed similar trends at the distal tibia. Despite these changes in bone quality, bone strength was maintained over the 18-month follow-up.

Conclusions: The observed changes in cortical bone structure are consistent with the effects of parathyroid hormone on intracortical bone remodeling. Controlled trials involving larger sample sizes are required to confirm the effects of teriparatide therapy on trabecular and cortical microarchitecture in the peripheral skeleton.

Keywords: Bone microarchitecture; Bone strength; HR-pQCT; Osteoporosis; Teriparatide
Links

DOI: 10.1007/s00198-010-1226-1

PubMed: 20458576

WoS: 000286003200043
History

Received: 2009-11-20

Accepted: 2010-03-01

Online: 2010-05-11

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2015	Zhou B. Bone Quality Assessment Using High Resolution Peripheral Quantitative Computed Tomography (HR-PQCT) [PhD thesis]. Columbia University; 2015.
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2020	Hiebert B. The Development of a Cortical Bone Turnover Model: Parathyroid Hormone Effects in the Rabbit [Master's thesis]. University of Saskatchewan; July 2020.
2021	Harrison KD. A Novel in Vivo Synchrotron Radiation Micro-CT Imaging Platform for the Direct Tracking of Remodeling Events in Cortical Bone [PhD thesis]. University of Saskatchewan; December 2021.