TERIPARATIDE (FORTEO) FOR INCREASING BONE MASS

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This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Osteogenesis imperfecta is an inherited autosomal dominant disorder of type I collagen characterized by multiple fractures and bone fragility fractures. OI affects approximately 1 to 2 out of every 10,000 individuals of all racial and ethnic origins. There is no cure for osteogenesis imperfecta and this is no established medical therapy for adults with the disorder. The purpose of this study is to determine the effectiveness of teriparatide (FORTEO) for increasing bone mass and improving bone structure in adults affected with Osteogenesis Imperfecta (OI). There are no data concerning the usefulness of parathyroid hormone (PTH) therapy in OI. An effective anabolic therapy available for the treatment of adult patients with OI would be an extremely attractive and valuable asset not only to the affected patients but also to the medical community at large. The working hypothesis is that individuals affected with OI who are treated with teriparatide will experience increased spine and hipbone mineral density and improvements in bone geometry (an increase in bone width and cortical thickness). The underlying pathophysiology of OI is a quantitative or qualitative abnormality in the synthesis of type I collagen, the most abundant protein in bone. Although teriparatide is not expected to change the defect in the collagen produced, it is expected to increase the quantite of bone formed. Therefore, we hypothesize that by increasing bone mineral density, overall bone strength will be enhanced in OI and fracture incidence will be reduced. The is a multi-site clinical efficacy and safety study that will be randomized, placebo-controlled and double-blinded. The three clinical sites that will participate are Oregon Health Sciences University (Reeder/Orwoll/Steiner), Johns Hopkins University (Shapiro), and Case Western University (Warman). Ninety adults with OI (of any type - 35 at each site) will be recruited from clinic rolls and announcements via the Osteoporosis Imperfecta Foundation for an 18-month placebo controlled, double-blinded trial of PTH (20mcg/day). Only those subjects who have no recent history of being treated with antiresorptive agents (treatment-naive) will be included in the study. The primary outcome variable will be BMD, but a variety of other variables will also be assessed including serum and urine markers of bone remodeling, quantitative computed tomography (QCT) measures of bone structure and safety parameters. DNA will be collected for possible future analyses.