J Endocrinol Metab

Journal of Endocrinology and Metabolism, ISSN 1923-2861 print, 1923-287X online, Open Access

Article copyright, the authors; Journal compilation copyright, J Endocrinol Metab and Elmer Press Inc

Journal website http://www.jofem.org

Case Report

Volume 2, Number 3, June 2012, pages 139-144

The Effects of Supraphysiologic Doses of Vitamin D3 in Conjunction With Teriparatide on Bone Mineral Density in Two Postmenopausal Females With Severe Osteoporosis

**Table 1.** Serum 25-Hydroxyvitamin D, Calcium, Phosphorus, Intact PTH, and Urine Cross-Linked N-Telopeptide at Baseline and 12 Month Intervals During Therapy With Teriparatide, Calcium Citrate and Supraphysiologic Doses of Vitamin D in Patients 1 and 2
Time (months)	Serum 25-hydroxyvitamin D (nmol/L) Reference range: 35 - 150	Serum calcium (mmol/L) Reference range: 2.05 - 2.55	Serum phosphorus (mmol/L) Reference range: 0.775 - 1.518	Serum PTH, intact (ng/L) Reference range: 10 - 65	Urine cross-linked N-telopeptide (nmol BCE/mmol creat) Reference range: 5 - 65
Laboratory values for patient 1; * Laboratory values for patient 2.
0*	39.93	2.125	0.710	65	75
12*	504.19	2.425	0.936	16	90
24*	394.36	2.325	0.839	22	64
0**	29.95	2.075	0.678	71	50
12**	304.51	2.50	0.969	15	86
24**	284.54	2.425	0.904	24	64

Table 1. Serum 25-Hydroxyvitamin D, Calcium, Phosphorus, Intact PTH, and Urine Cross-Linked N-Telopeptide at Baseline and 12 Month Intervals During Therapy With Teriparatide, Calcium Citrate and Supraphysiologic Doses of Vitamin D in Patients 1 and 2

Time (months)

Serum 25-hydroxyvitamin D (nmol/L) Reference range: 35 - 150

Serum calcium (mmol/L) Reference range: 2.05 - 2.55

Serum phosphorus (mmol/L) Reference range: 0.775 - 1.518

Serum PTH, intact (ng/L) Reference range: 10 - 65

Urine cross-linked N-telopeptide (nmol BCE/mmol creat) Reference range: 5 - 65

*Laboratory values for patient 1; ** Laboratory values for patient 2.

39.93

2.125

0.710

12*

504.19

2.425

0.936

24*

394.36

2.325

0.839

0**

29.95

2.075

0.678

12**

304.51

2.50

0.969

24**

284.54

2.425

0.904

**Table 2.** Comparison of BMD and T-Scores Prior to and 24 Months After Treatment With Teriparatide, Calcium Citrate and Supraphysiologic Doses of Vitamin D in Patients 1 and 2, Percent Change and Absolute Increase in BMD is Also Noted
	Patient 1	Patient 2
BMD, L1-L4 (g/cm²), baseline	0.393	0.351
BMD, L1-L4 (g/cm²), at 24 months	0.582	0.639
T-score, L1-L4, baseline	-5.9	-6.3
T-score, L1-L4, at 24 months	-4.2	-3.7
% change in BMD, L1-L4, at 24 months	48.2%	82.3%
Absolute increase in BMD at 24 months (g/cm²)	0.189	0.288

Table 2. Comparison of BMD and T-Scores Prior to and 24 Months After Treatment With Teriparatide, Calcium Citrate and Supraphysiologic Doses of Vitamin D in Patients 1 and 2, Percent Change and Absolute Increase in BMD is Also Noted

Patient 1

Patient 2

BMD, L1-L4 (g/cm²), baseline

0.393

0.351

BMD, L1-L4 (g/cm²), at 24 months

0.582

0.639

T-score, L1-L4, baseline

-5.9

-6.3

T-score, L1-L4, at 24 months

-4.2

-3.7

% change in BMD, L1-L4, at 24 months

48.2%

82.3%

Absolute increase in BMD at 24 months (g/cm²)

0.189

0.288

**Table 3.** Comparison of Changes in Bone Mineral Density From Baseline Values in Our Patients After 24 Months of Teriparatide, Calcium Citrate and Supraphysiologic Doses of Vitamin D; With Patients Treated With Teriparatide, Calcium and Physiologic Doses of Vitamin D^a
	Patients treated with teriparatide and physiologic doses of vitamin D	Patient#1	Patient#2
^aResults from Eli Lilly pharmaceutical clinical trial. The safety and efficacy of once-daily teriparatide and physiologic doses of vitamin D with a median exposure of 19 months were examined in a double-blind, multicenter, placebo-controlled clinical trial of 1,637 postmenopausal women with osteoporosis [2].
Percent Change in BMD at the Lumbar Spine over 24 months	9.7%	48.2%	82.3%
Absolute increase in g/cm² over 24 months	-	0.189	0.288

Table 3. Comparison of Changes in Bone Mineral Density From Baseline Values in Our Patients After 24 Months of Teriparatide, Calcium Citrate and Supraphysiologic Doses of Vitamin D; With Patients Treated With Teriparatide, Calcium and Physiologic Doses of Vitamin D^a

Patients treated with teriparatide and physiologic doses of vitamin D

Patient#1

Patient#2

^aResults from Eli Lilly pharmaceutical clinical trial. The safety and efficacy of once-daily teriparatide and physiologic doses of vitamin D with a median exposure of 19 months were examined in a double-blind, multicenter, placebo-controlled clinical trial of 1,637 postmenopausal women with osteoporosis [2].

Percent Change in BMD at the Lumbar Spine over 24 months

9.7%

48.2%

82.3%

Absolute increase in g/cm² over 24 months

0.189

0.288