Abstract
The present pilot study investigated the effect of Teriparatide 1–34 rh-PTH (TPT) in young women diagnosed with anorexia nervosa (AN), and markedly compromised Bone Mineral Density (BMD). Patients were included who had (i) very low BMD (defined as Z-Score < − 2.5 or T-Score < − 2.5 if available) in at least one of the assessed localizations (lumbar spine L1–L4, total hip, femoral neck) without any previous fragility fracture; or (ii) low bone mineral density (defined as Z-Score < − 1.5 or T-Score < − 1.5 if available) in at least one of the assessed localizations (lumbar spine L1–L4, total hip, femoral neck) and at least one previous fragility fracture. Ten patients with an age range of 21–33 were recruited and their bone outcome was assessed after 12, 18, and 24 months. After 24 months of TPT treatment, BMD improved by 13.5% in the spine, 5.0% in the femoral neck, and 4.0% in the hip. Radius cortical bone density (− 2.6%) and radius cortical thickness (− 6.4%) decreased significantly, while in tibia there was no significant decrease. Neither in radius nor in tibia a significant change in trabecular bone parameters occurred. During the treatment, the patients’ body weight did not increase significantly. Patients did not experience severe adverse events; only mild side effects were observed. Although these results emerged from a single-arm prospective study, it seems that AN patients with a severely compromised bone situation can benefit from TPT. Larger studies are needed to ascertain the effect of this promising substance.
Highlights
Anorexia Nervosa (AN) is a psychiatric illness that affects about one percent of women, mostly at a young age [1]
Very low bone mineral density is defined as a Z-Score at screening of lower than − 2.5 in one or more of the assessed areas (L1–L4, total hip or femoral neck); (ii) low bone mineral density with at least one previous fragility fracture
The primary endpoint consisted in testing the effect of TPT treatment during a period of 24 months in the lumbar spine, femoral neck and total hip Bone Mineral Density (BMD) in patients with severe AN with an age range 21–33, very low bone mineral density and increased bone fragility
Summary
Anorexia Nervosa (AN) is a psychiatric illness that affects about one percent of women, mostly at a young age [1]. Weight recovery and long term weight stabilization is the best treatment for low BMD in AN, coupled with a return of normal menses [6]; since only 50–60% of women with AN recover even two decades after their diagnosis [7, 8], pharmacological treatment options are needed to reduce the chronic bone loss and the consequent increase in fracture risk. There is no approved pharmacological treatment to target bone loss in AN [5]. Teriparatide (TPT), the recombinant human 1–34 parathyroid hormone, is a bone anabolic agent that is approved for the treatment of postmenopausal osteoporosis in women, hypogonadal osteoporosis in men, and glucocorticoid induced osteoporosis. All patients had very low BMD in at least one of the assessed localizations (lumbar spine L1–L4, total hip, femoral neck) without any previous fragility fracture, or low BMD in at least one of the assessed localizations (lumbar spine L1–L4, total hip, femoral neck) and at least one previous fragility fracture
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