Long-Term Effects of Teriparatide Followed by Antiresorptive Therapy on Clinical Outcomes in Patients with Severe Spinal Osteoporosis

Abstract

Teriparatide (TPTD) is the most widely used anabolic agent in the treatment of patients with osteoporosis although its use is restricted in many countries. A recent randomised trial confirmed that TPTD was superior to risedronate at preventing vertebral fractures over a 2-year period. There is limited information on the relative effectiveness of TPTD compared with standard care in routine clinical practice. In this paper, we report the results of an extended observational study of 724 women referred to a specialist clinic with severe osteoporosis over an 11.5-year period, who were considered for TPTD therapy. Of these patients, 496 (68.5%) were treated with TPTD, whereas the remaining 228 (31.5%) received other treatments. This was either because they were unwilling or unable to self-inject (52.6%), because they had already been established on oral bisphosphonates (31.1%) or because of contraindications (12.7%). The TPTD group were younger than the standard care group (69.6 vs. 74.1 years) and had a lower 10-year fracture risk (25.7% vs. 28.6%). Those treated with TPTD had a greater increase in BMD at the lumbar spine compared with standard care (13.3% vs. 8.2%, p < 0.001) after approximately 2 years and had a lower incidence of vertebral fractures (4.8% vs. 10.1%, p = 0.01) over the course of our observation. There was no difference between groups with respect to either BMD change at the femoral neck or incidence of non-vertebral fractures. This study confirms that TPTD is superior to standard care at reducing the risk of vertebral fracture in patients with severe osteoporosis.

Management of Osteogenesis Imperfecta

“…Teriparatide (TPTD) is the 1-34 fragment of parathyroid hormone. It has been successfully used for many years in the treatment of osteoporosis and has been found to be superior to bisphosphonates in the prevention of vertebral fractures in severe osteoporosis in observational studies (45). Moreover, TPTD was found to be superior to oral risedronate in preventing vertebral fractures in a double-blind randomized trial of individuals with severe osteoporosis (46).…”

Genome-wide association study identifies genetic variants which predict the response of bone mineral density to teriparatide therapy

“…Although TPTD is more effective than oral bisphosphonates in this situation, there is greater burden for the patient in that the standard course of therapy involves daily self-administered subcutaneous injections for a 2-year period. Reflecting this fact, a previous audit based in the Edinburgh centre reported that 15.8% of patients who were offered TPTD therapy declined because they were unwilling to self-inject 18…”

Communicating Absolute Fracture Risk Reduction and the Acceptance of Treatment for Osteoporosis

“…For anabolic drugs like teriparatide and romosozumab we assumed that the reduction in risk of fracture during treatment would be sustained for 5 years as the result of follow-on treatment with antiresorptive medication. Although this has not yet been proven for romosozumab, observational studies suggest that the beneficial effects of teriparatide are sustained following introduction of antiresorptive therapy for at least 5 years [ 15 ].…”