Date of Graduation

Summer 8-10-2013

Degree Type

Capstone Project

Degree Name

Master of Science in Physician Assistant Studies

First Advisor

Annjanette Sommers, PA-C, MS

Second Advisor

Eric Foote, PA-C, MS

Third Advisor

Mark Pedemonte, MD

Abstract

Background: Glucocorticoids have a wide-range of beneficial effects for treating inflammatory, allergic, and immunologic conditions. However, glucocorticoid therapy can lead to increased bone resorption and reduced bone formation by inhibiting osteoblast proliferation. This bone deterioration leads to osteoporosis. When considering therapy for prevention of fractures in glucocorticoid-induced osteoporosis (GIO), teriparatide (recombinant human parathyroid hormone 1-34) is an anabolic agent that can be used to improve bone mineral density (BMD) and prevent fractures. Due to bone deterioration caused by glucocorticoid therapy, prevention of bone fractures has significant importance. While there are several choices for therapy for prevention of GIO, the anabolic agent teriparatide could show a more significant improvement of BMD and of preventing fractures resulting from GIO. The purpose of this systematic review of the literature is to evaluate the efficacy of teriparatide in prevention of fractures that can result from glucocorticoid therapy.

Methods: An extensive literature search was conducted using Medline-OVID, CINAHL, Evidence Based Medicine Reviews Multifile, and Web of Science using the search terms: teriparatide, osteoporosis, fractures, and glucocorticoids. The reference sections of each of these articles were further searched for additional relevant sources. Articles were screened and evaluated for relevance using GRADE.

Results: Two studies met inclusion criteria for this systematic review that included two randomized control trials. These studies demonstrated that patients who were on teriparatide had increased BMD. Both studies also measured fracture rates and showed a decrease favoring teriparatide.

Conclusion: There is sufficient evidence to recommend teriparatide as a therapeutic option for reversing the effects of glucocorticoid-induced osteoporosis by improving bone mineral density and preventing the occurrence of fractures, although there may still remain a question of safety that would warrant continued research.

Keywords: teriparatide, fractures, osteoporosis, and glucocorticoids.

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