Changes of the quality of life under treatment of severe senile osteoporosis with teraparatide

Despite being treated with antiresorptive drugs, the severe osteoporosis (SO) is being considered as acondition in which patients are still subject to one or more vertebral or femoral fractures, or nonvertebralor non-femoral fractures, i.e., of other parts of the body such as the wrist, shoulder, tibia, ribs orhip. These patients are defined as non-responders (NRs) to the antiresorptive therapy, and recentresearch has shown that they represent 10–25% of all SO patients. During the last almost 3 years a newdrug has become available in Italy, called teriparatide (rh-PTH-1-34), produced in Escherichia coli usingthe recombinant-DNA technique. It shows remarkable trophic and anabolic actions on the bones, andproved to be very useful for treating the osteoporosis in general. This study describes our experience inusing teriparatide for the treatment of SO in a sample of 141 elderly women of mean age 73.4 5.8 years,with a mean number of fractures of 3.0 0.85, with a spine deformity index (SDI) of 5.92 1.27 and a meanvertebral T-Score (L1–L4) of 3.15 0.39, and a mean femoral T-Score of 2.50 0.28. All these patients hadbeen treated with antiresorptive drugs for at least 1 year: specifically 70 of them with Alendronate, 42 of themwith Risedronate and 29 of them with Raloxifene. For 18 months, all these patients were injectedsubcutaneously with 20 mg of teriparatide, with the daily addition of 1 g of calcium and 880 IU of vitamin D.The study was continued for 24 months, at the end of which the patients continued to take only calcium andvitamin D. The patients underwent a CBM-DEXA control of vertebral column and femur every 6 months, andthey were also administered a Quality-of-Life Questionnaire of the European Foundation for Osteoporosis(QUALEFFO). The QUALEFFO (41 items) questionnaire to evaluate the changes in the quality-of-life (QoL) andthe consumption of non-steroidal anti-inflammatory drugs (NSAIDs) was also recorded. The results showedthat teriparatide protected 96.5% against new fractures (only five new fractures occurred), bone mineraldensity (BMD) increased approximately by 12% in the vertebral column and by 11% in the femur, consumptionof NSAIDswas reduced at the early stage approximately 80%, the QoL improved considerably and remained soduring the 18 months of teriparatide treatment, with only a slight decrease during the 6 subsequent months. 2008 Elsevier Ireland Ltd. All rights reserved