Endocrine Abstracts

Teriparatide (PTH 1-34) is licensed for treatment of osteoporosis in postmenopausal women and in men at increased risk of fractures and treatment of corticosteroid-induced osteoporosis. It is administered as a daily subcutaneous injection for two years. It is used in patients with severe osteoporosis who have not responded to, or not been able to tolerate bisphosphonate treatment. It is contraindicated in hypercalcaemia, bone cancer, bone radiotherapy and Paget’s disease. Non-response to bisphosphonates includes new fractures on treatment or decreasing BMD. Bone turnover markers are useful is assessing response, especially to oral bisphosphonates. Teriparatide increases BMD and decreases vertebral and non-vertebral fractures by more than 50%. Treatment needs to be continued with an anti-resorptive which can be challenging in patients with contraindications or intolerance of bisphosphonates. Romosozumab is a sclerostin antibody, which disinhibits bone formation. It is licensed for the treatment of severe osteoporosis in postmenopausal women at increased risk of fractures. It is administered as a monthly subcutaneous injection for 12 months. It reduces vertebral fractures by 70% compared with placebo and 40% compared with alendronate. It is contraindicated in patients who have had stroke and myocardial infarction due to excess events in the ARCH trial (vs alendronate). NICE have approved romosozumab for first-line treatment in women who have had a major osteoporotic fracture within the last two years and have low BMD. Cardiovascular risk factors should be considered and discussed with patients. Follow-on treatment with an antiresorptive is required to maintain the increase in BMD. Neer et al N Engl J Med 2001;344(19):1434-41 Cosman N Engl J Med 2016; 375(16):1532-1543 Saag N Engl J Med 2017; 377:1417-1427 NICE TA161, TA791