Two-year changes in bone mineral density and T scores in patients treated at a pharmacist-run teriparatide clinic

Study Objectives. To determine changes in bone mineral density (BMD) and T scores of patients after 2 years of teriparatide therapy, and to determine the number of fractures that occurred during therapy Design. Prospective, observational study. Setting. Pharmacist-run teriparatide clinic in a private-practice endocrinology group. Patients. Sixty patients with osteoporosis who experienced fractures or adverse events while receiving antiresorptive therapy and were referred by the endocrinologists to the clinic between January 1, 2002, and January 1, 2004. Intervention. After a 1-hour counseling and training session with a clinical pharmacist, patients self-administered subcutaneous teriparatide 20 μg/day for the next 2 years. Measurements and Main Results. Primary outcome measures were dual x-ray absorptiometry-determined BMDs and T scores for the total hip, spine, and wrist at baseline and at 1 and 2 years. Patients' BMDs for the hip significantly increased by 3.5% at 1 year and by 3.9% at 2 years. In addition, BMD for the spine significantly increased by 7.2% at 1 year and 10.9% at 2 years. In 56 (93%) patients, BMD for the spine increased after 2 years of treatment. For the wrist, BMD decreased by 0.75% at 1 year and by 2.4% at 2 years, but the change was only significant at 2 years (p=0.011). At both 1 and 2 years, T scores for the total hip and spine significantly improved from baseline (p≤0.019), whereas T scores for the wrist significantly declined after 2 years of therapy (p<0.003). No new fractures were documented in any of the patients. Conclusion. In patients with osteoporosis, the use of teriparatide in a pharmacist-run clinic significantly increased BMD at the total hip and spinal sites and significantly decreased BMD in the wrist.