Osteoporosis management following teriparatide therapy for vertebral fractures: Are patients on correct maintenance therapy?
Daniel Gilmartin, Mortimer B. O’Connor, Siobhan Scanlon, Ursula Bond, Mark J. Phelan
The Department of Rheumatology, South Infirmary Victoria University Hospital, Cork, Ireland
Teriparatide is used as a daily subcutaneous therapy for severely osteoporotic patients, with therapy duration of 18 to 24 months. It functions as an anabolic agent, and demonstrates increases in cortical thickness and reduces fracture risk. For the benefits of teriparatide to be sustained antireabsorbative therapy, in combination with calcium/vitamin D supplementation, should be initiated/restarted long-term after teiparatide therapy.
The aim of this study are to assess patients medication history following teriparatide therapy completion.
All patients prescribed teriparatide therapy from 2009 to 2012 were identified from departmental prescription records. Contact information was identified from local hospital databases. Patients were sent a pre-study letter outlining the nature of the study and the questions. This was followed by a telephone call, within two weeks, from the investigators. Three telephone attempts were made to contact participants after which they were excluded from the study. Participants were asked to list their current medications, background diagnoses and if they sustained a fracture since completing teriparatide therapy.
113 patients were identified from records. 42 were contacted and consented to participate in the study, 16 were deceased and 55 were uncontactable despite three attempts. Of the 42 enrolled, 45.2% (n=19) were no longer on a calcium or vitamin D supplementation and 57.1% (n=24) were no longer on an anti-reabsorbative, despite it being prescribed at their postteriparatide Rheumatology assessment prior to discharge to GP care.
Despite being prescribed an anti-reabsorbative osteoporosis medication and calcium/Vitamin D supplementation on completion of teriparatide therapy there was a significant number of patients who no longer took these medications. The reasons for discontinuation are undocumented. This leaves them exposed to a submaximal benefit from therapy and an increased future fracture risk. This care-gap needs to be tackled.