ReviewLiterature review: The effects of teriparatide therapy at the hip in patients with osteoporosis

- Teriparatide treatment improves bone quality and architecture.
- Teriparatide increases hip bone formation and areal and volumetric BMD.
- Teriparatide increases cortical thickness and estimated hip strength.
- Teriparatide reduces nonvertebral fracture risk, an endpoint including hip.
- While available data suggest beneficial effects of teriparatide at the hip, effects of teriparatide on hip fracture risk are unknown.

Teriparatide is a skeletal anabolic treatment for patients with osteoporosis at high risk for fracture. Because adequate clinical trials have not yet been conducted to assess the efficacy of teriparatide for reducing the risk of hip fracture, we review here the literature regarding how treatment with teriparatide affects the hip in patients with osteoporosis. Teriparatide increases cancellous bone volume, improves bone architecture, and - uniquely among osteoporosis treatments - increases cortical thickness and cortical porosity. By bone scan and positron emission tomography, teriparatide increases bone formation throughout the skeleton, including the hip. Consistent with these findings, studies using dual-energy X-ray absorptiometry and quantitative computed tomography for longitudinal assessment of changes at the hip have consistently shown increases in areal and volumetric bone mineral density, cortical thickness, and finite element-estimated hip strength in patients treated with teriparatide. Finally, in clinical fracture-outcome trials, treatment with teriparatide has been shown to reduce the risk of nonvertebral fracture, a composite endpoint that includes hip fracture. Taken together, this body of evidence suggests that teriparatide positively affects the hip in patients with osteoporosis.