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Teriparatide for treatment of patients with bisphosphonate-associated atypical fracture of the femur

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Abstract

Summary

The Fracture Improvement with Teriparatide (Fix-IT) study randomized 13 women with an atypical femur fracture to immediate vs delayed teriparatide therapy; all were followed for 12 months. Results suggested a trend for superior healing and lesser bone mineral density declines in the immediate vs delayed group with no differences in adverse events.

Purpose

Little clinical data are available on the use of teriparatide for the treatment of bisphosphonate-associated atypical femur fractures (AFF). The goal of the Fix-IT study was to determine if immediate therapy with teriparatide was superior for fracture healing after an AFF compared to a 6-month delay in teriparatide therapy.

Methods

This randomized pilot clinical trial included 13 women with an AFF who were randomized to immediate teriparatide vs a delay of 6 months. All were followed for 12 months on teriparatide. The primary outcomes included individual and composite measures of radiologic bone healing (scored 1 point [no healing] to 4 points [complete healing]) at 6 and 12 months. Secondary outcomes included bone mineral density of the unfractured contralateral hip, spine, 1/3 distal radius, and adverse events.

Results

We found there was a trend for superior healing with the composite score (12.6 vs 11.2 at 6 months and 15.4 vs 13.2 at 12 months), and lesser bone mineral density declines at the 1/3 distal radius (12-month change − 1.9 vs − 6.1%) in the immediate vs the delayed group. There were no differences in adverse events. There was one implant failure in the delayed group.

Conclusions

There is a preliminary signal for greater improvements with immediate teriparatide therapy vs delayed therapy. However, because an AFF is a rare event, and only a small number of patients were included, the results must be interpreted with caution.

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Acknowledgements

Drs. Greenspan and Perera received support for an investigator initiated proposal from Eli Lilly.

Author information

Authors and Affiliations

  1. Department of Medicine, University of Pittsburgh, 3471 Fifth Avenue, Suite 1110 Kaufmann Medical Building, Pittsburgh, PA, 15213, USA

    S. L. Greenspan, K. Vujevich & S. Perera

  2. Department of Radiology, University of Pittsburgh Physicians, Pittsburgh, PA, USA

    C. Britton & A. Herradura

  3. Department of Orthopedic Surgery, University of Pittsburgh Physicians, Pittsburgh, PA, USA

    G. Gruen, I. Tarkin, P. Siska & B. Hamlin

Authors
  1. S. L. Greenspan
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  2. K. Vujevich
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  3. C. Britton
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  4. A. Herradura
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  5. G. Gruen
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  6. I. Tarkin
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  7. P. Siska
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  8. B. Hamlin
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  9. S. Perera
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Corresponding author

Correspondence to S. L. Greenspan.

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Conflict of interest

Dr. Greenspan has received research grants from Eli Lilly and Amgen; Drs. Britton, Herradura, Gruen, Tarkin, Siska, Hamlin, Perera, and K. Vujevich have no disclosures.

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Greenspan, S.L., Vujevich, K., Britton, C. et al. Teriparatide for treatment of patients with bisphosphonate-associated atypical fracture of the femur. Osteoporos Int 29, 501–506 (2018). https://doi.org/10.1007/s00198-017-4286-7

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  • DOI: https://doi.org/10.1007/s00198-017-4286-7

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