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This version published online on December 21, 2004
Journal of Clinical Endocrinology & Metabolism, doi:10.1210/jc.2004-0826
A more recent version of this article appeared on March 1, 2005
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Submitted on May 7, 2004
Accepted on December 1, 2004

Teriparatide reduces the fracture risk associated with increasing number and severity of osteoporotic fractures

J. Christopher Gallagher, Harry K. Genant, Gerald G. Crans, Socorro Juan Vargas, and John H. Krege*

Bone Metabolism Section, Creighton University Medical Center, Omaha, NE; Osteoporosis and Arthritis Research Group (OARG), University of California, San Francisco, CA; Synarc, Inc, San Francisco, CA; Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN; Department of Endocrinology, William W. Backus Hospital, Norwich, CT

* To whom correspondence should be addressed. E-mail: krege john henry{at}lilly.com.

The relationship between prior fractures and risk of new fractures was evaluated in 931 postmenopausal women with prevalent vertebral fractures randomized to daily placebo or teriparatide 20 µg in the Fracture Prevention Trial. Median observation was 21 months. Among placebo patients with 1, 2, or ≥ 3 prevalent vertebral fractures, 7%, 16%, and 23%, respectively, developed vertebral fractures (Cochran-Armitage trend test, P < 0.001) and 3%, 9%, and 17% developed moderate or severe vertebral fractures (P < 0.001). Among placebo patients with mild, moderate, or severe prevalent vertebral fractures, 10%, 13%, and 28%, respectively, developed vertebral fractures (P < 0.001) and 4%, 8%, and 23% developed moderate or severe vertebral fractures (P < 0.001). Among placebo patients with 0, 1, or ≥ 2 prior nonvertebral fragility fractures, 4%, 8%, and 18%, respectively, developed nonvertebral fragility fractures (P < 0.001). In the teriparatide treated group, there was no significant increase in vertebral or nonvertebral fracture risk in these subgroups.

In summary, the number and severity of prevalent vertebral fractures independently predicted the risk for new vertebral fractures, and the number of prior nonvertebral fractures predicted risk for new nonvertebral fractures in placebo patients. However, in teriparatide treated patients, the increased fracture risk associated with prior number and severity of fracture was not observed.
Key words: Teriparatide • parathyroid hormone • postmenopausal osteoporosis • vertebral fracture • nonvertebral fracture • fracture cascade




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