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1266 - The Effect of Teriparatide Treatment on Bone Mineral Density in Persons with Chronic Spinal Cord Injury and Osteoporosis

Friday, February 28, 2025

5:00 PM - 6:30 PM MST

Presenting Author(s)

SS

Samir Sherali, MD

Resident Physician
MetroHealth Rehabilitation Institute / Case Western Reserve University
Cleveland, Ohio, United States

Co-Author(s)

RR

Ryan L. Russell, DO

Resident Physician
MetroHealth Rehabilitation Institute / Case Western Reserve University
Cleveland, Ohio, United States
CO

Christina V. Oleson, MD

Director, Neuro-Osteoporosis Program, and Professor of Physical Medicine and Rehabilitation
Case Western Reserve/MetroHealth Rehabilitation Institute
Cleveland, Ohio, United States

Objectives: Sublesional disuse osteoporosis is a known complication after acute spinal cord injury(SCI) that continues to progress in chronic SCI. With immobilization and lack of weight bearing, along with upregulation of osteoclastic activity and subsequent reduction of osteoblastic activity 1-2 years post-injury, a net resorption of bone ensues. Individuals with chronic SCI who have experienced significant bone loss would benefit from aggressive treatment that builds bone, rather than merely lessening the rate of bone loss. The parathyroid hormone analog teriparatide has known benefits for osteoporosis in the general population. The primary objective of this study was to evaluate treatment response of teriparatide on bone mineral density in persons with chronic spinal cord injury.

Design: Five patients with chronic complete SCI and diagnosed sublesional osteoporosis based on bone mineral density(BMD) using dual-energy X-ray absorptiometry(DXA) received 2 years of teriparatide treatment. Changes in BMD on DXA were measured before and after teriparatide.

Results: Respective changes in BMD in the nondominant limb for Total Hip(TH), Femoral Neck(FN), Distal Femur(DF), and Proximal Tibia(PT) are as follows: Participant 1 (0.087, 0.184, DF and PT unavailable), Participant 2 (0.027, 0.010, -0.097, -0.086), Participant 3 (0.030, -0.006, 0.066, 0.173), Participant 4 (-0.006, -0.004, 0.065, 0.075), Participant 5 (0.028, 0.029, 0.035, 0.243). This represents an average improvement in BMD of 5.6% in TH, 6.0% in FN, 4.6% in DF, 23.9% in PT. These 5 individuals showed either improvement or minimal change in BMD at the TH and FN. Additionally 3 of 4 individuals with available data demonstrated BMD gains at the DF and PT.

Conclusions: Teriparatide may have a role in the treatment of osteoporosis in individuals with chronic SCI. While this study is limited both in quantity and lack of comparison to a control group, the findings support the need for further investigation.