Efficacy and Safety of Teriparatide in the Treatment of Nontraumatic Osteonecrosis of the Femoral Head

Introduction

Complete collapse of the femoral head is one of the major complications of nontraumatic osteonecrosis (NOFH), resulting in dysfunction of the hip and disability in patients. It occurs in 75% of NOFH cases within three years and in 80% of patients within four years of onset of hip pain.

Aim

To examine pharmacological effects of teriparatide on collapse progression of NOFH and to compare these effects with alendronate

Patient Profile

NOFH patients diagnosed with osteoporosis

Methods

· Retrospective study

·Collapse progression with > 1 mm was defined as advanced collapse, while with < 1 mm was defined as stable radiologic disease

Results

• Teriparatide had a tendency to reduce collapse progression of femoral head (p = 0.105)

• Treatment with teriparatide resulted in significant reduction in collapse progression (0.67 mm) compared to that with alendronate (1.24 mm; p = 0.049)

• Kaplan-Meier curves for stable radiologic disease showed that teriparatide-treated patients had better stable states than those treated with alendronate (p = 0.08, log-rank test).
  • Patients treated by teriparatide showed a longer 1-year stability (83.3%) than patients treated by alendronate (53.6%, p = 0.08, log-rank test)
• No complications were observed on the patients during the period of study caused by the treatment course of teriparatide or alendronate

Conclusion

• The treatment with teriparatide resulted in lesser collapse progression of the femoral head than that by alendronate
• Teriparatide has greater pharmacological effects than alendronate for treating NOFH and preventing the collapse of femoral head
• Teriparatide is a potent conservative option for treatment of NOFH

Reference

BMC Musculoskeletal Disorders.2017;18:24