Background: We studied the use of teriparatide in postmenopausal women with severe osteoporosis.
Material/Methods: Two groups (A and B) of patients affected by severe osteoporosis (T-score ≤–2.5 at bone mineral density were analyzed and 2 vertebral fractures on radiograph).
Group A was treated for 18 months with 20 µg/day of teriparatide. Group B was treated with bisphosphonates 70 mg/week. Every woman assumed 1 g of calcium and 800 IU of vitamin D3 daily. We evaluated the effects of therapy after 18 months (T18) from the beginning with bone turnover markers (alkaline phosphatase, procollagen type 1 N-terminal propeptide, and N-telopeptide cross-links) and dual-energy X-ray absorptiometry.
Results: Group A, at T18 procollagen type 1 N-terminal propeptide levels, increased 127%; bone alkaline phosphatase levels increased to 65%; N-telopeptide cross-links levels increased to 110%.
Group B, at T18 procollagen type 1 N-terminal propeptide levels, decreased to 74%; bone alkaline phosphatase levels decreased to 41%; N-telopeptide cross-links levels decreased to 72%.
After 18 months, lumbar bone mineral density increased to 12.4% and femoral bone mineral density increased to 5.2% in group A. Group B lumbar bone mineral density increased to 3.85% and femoral bone mineral density increased to 1.99%. Only a new vertebral fracture occurred in group A (2.4%), whereas 6 fractures occurred in group B (15.7%).
The quality of life questionnaire of the European Foundation for Osteoporosis (QUALEFFO) revealed a significant improvement in daily living, performed domestic jobs, and locomotor function in groups A and B.
Conclusions: The use of rhPTH in patients with severe osteoporosis offers more protection against fractures and improves the QoL more than bisphosphonates.

Keywords: Osteoporosis, Postmenopausal - drug therapy, Fractures, Bone - prevention & control, Cohort Studies, Bone and Bones - metabolism, Bone Density Conservation Agents - therapeutic use, Bone Density - drug effects, Biological Markers - metabolism, Alendronate - therapeutic use, Prospective Studies, Quality of Life, Spine - pathology, Teriparatide - therapeutic use