Introduction: Teriparatide, a parathyroid hormone (PTH 1-34), has been used to treat osteoporosis by promoting bone formation. In this study, we subcutaneously (SC) injected 20 ug of teriparatide daily for at least 1 year in 42 patients with osteoporotic hip fracture and observed the change of bone mineral density (BMD) and serum level of bone turnover markers (BTMs); Bone alkaline phosphatase (B-ALP), C-telopeptide of type I collagen (CTX) and 25(OH) Vitamin D3 (Vit. D).

Materials and Methods: A total of 42 patients underwent daily subcutaneous injection of 20ug teriparatide after acute hip fracture for at least 1 year. There were 12 males and 30 females with an average age of 74.2 years and mean follow-up duration was 13.2 months. Forty-one patients (97.6%) took an oral agent with a combination of calcium/vitamin D simultaneously. Radiographic evaluation including BMD at lumbar spine, total hip and femur neck before and 1 year after injection in all patients. BTM levels were measured before and at 3 months, 6 months and 1 year after injection. We analyzed correlation between BMD and BTM, and between BTMs.

Results: BMD significantly increased at lumbar spine (7.3%, p=0.019). Serum B-ALP level increased steadily for 6 months, then decreased, but maintained a 23% increase at 1 year compared with that before injection (p<0.05). Serum CTX level increased rapidly at 3 months and maintained a 31.57% increase at 1 year compared with that before injection. Serum Vit. D level at 3 months, 6 months, and 1 year increased compared with that before injection, but were below the normal reference range. Serum B-ALP and CTX level showed positive correlations at 3 months (r=0.482), 6 months (r=0.400) and 1 year (r=0.379) after injection (p<0.05). With serum Vit. D3 level, B-ALP and CTX levels showed a positive correlation at 3 months (r= 0.413 and r=0.373, respectively) and at 6 months (r=0.456, and r=0.306, respectively) after injection (p<0.05).

Conclusion: Daily subcutaneous injection of 20ug teriparatide for 1 year after acute hip fracture increased lumbar spine BMD and serum B-ALP and CTX levels significantly. Increased serum B-ALP for 6 months and CTX for 3 months may suggest positive balance of bone remodeling in patients with hip fracture after daily subcutaneous injection of 20ug teriparatide.