Changes in bone mineral density and bone turnover markers during treatment with teriparatide in pregnancy‐ and lactation‐associated osteoporosis

Summary Context Teriparatide ( TPTD ) therapy has been proposed as a potential treatment strategy in severe cases of pregnancy‐ and lactation‐associated osteoporosis ( PLO ) characterized by the occurrence of fragility fractures in the third trimester or early postpartum. Objective To investigate the changes in bone mineral density ( BMD ) and bone turnover markers in patients with PLO with and without TPTD treatment. Design Retrospective cohort study. Patients Thirty‐two patients with PLO who presented with multiple vertebral fractures to a tertiary institution between 2007 and 2015 were included. Measurements Changes in BMD at the lumbar spine ( LSBMD ) and proximal femur after 12 months of daily subcutaneous injections of 20 μg TPTD (n = 27) were assessed. Subjects who rejected the TPTD treatment were used as controls (n = 5). Results LSBMD increased in both subjects treated with TPTD and controls, with greater increases in the TPTD group (15.5 ± 6.6% vs 7.5 ± 7.1%, P  = .020) after adjustment for age and baseline LSBMD . During follow‐up, serum levels of osteocalcin ( OCN ) and C‐telopeptide of type I collagen ( CTX ) increased significantly in the TPTD group. In multivariate linear regression models, TPTD treatment (adjusted β = 7.92, P  =   .032) and younger age (adjusted β = 1.06, P  =   .046), but not baseline LSBMD , body mass index, serum OCN level and CTX level, were independently associated with greater increases in LSBMD . Conclusions In patients with PLO , LSBMD at 12 months increased in both the TPTD ‐treated and control groups. TPTD treatment and younger age were associated with greater increases in LSMBD irrespective of baseline LSBMD .