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Teriparatide reduces fracture risk in women with severe osteoporosis
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Postmenopausal women with severe osteoporosis may have a lower risk for new vertebral fractures when treated with the anabolic agent teriparatide compared with risedronate, an antiresorptive therapy, study data show.
Piet Geusens, MD, PhD, honorary professor of rheumatology, department of internal medicine, subdivision of rheumatology at Maastricht University Medical Center in the Netherlands, and colleagues evaluated data from the Vertebral Fracture Treatment Comparisons in Osteoporotic Women (VERO) trial on 1,360 postmenopausal women (mean age, 72.1 years; 97.3% white) with established osteoporosis randomly assigned to 20 µg subcutaneous teriparatide (Forteo, Lilly) once per day plus oral weekly placebo (n = 680) or to 35 mg oral risedronate once per week plus daily injections of placebo (n = 680) for up to 24 months. Researchers sought to determine the incidence of new radiographic vertebral fractures.
Participants had at least two moderate fractures or one severe baseline vertebral fracture. Mean number of prevalent vertebral fractures was 2.7, and 89.6% had at least one severe vertebral fracture at baseline.
The treatment effect was superior with teriparatide compared with risedronate (incident rate of new vertebral fracture, 5.4% vs. 12%; RR = 0.44; 95% CI, 0.29-0.68). In subgroups of patients, the treatment effect of teriparatide was superior to that of risedronate for those with two prevalent vertebral fractures (RR = 0.28; 95% CI, 0.09-0.81), those with a prior major nonvertebral fracture (RR = 0.27; 95% CI, 0.13-0.58), the oldest participant group (aged 76.8 years; RR = 0.33; 95% CI, 0.15-0.73) and participants with a clinical vertebral fracture within 12 months before entering the study (RR = 0.35; 95% CI, 0.2-0.62). Overall efficacy results were not statistically different in participants with recent bisphosphonate use.
Participants in the teriparatide group had a lower cumulative incidence of new clinical fracture compared with the risedronate group (4.8% vs. 9.8%; HR = 0.48; 95% CI, 0.32-0.74).
“Data for the first time indicate the additional fracture benefit of using an anabolic compared to an antiresorptive across multiple patient clinical scenarios,” the researchers wrote. “This information should aid in positioning teriparatide bone anabolic therapy for reduction of residual fracture burden in patients at high fracture risk who are either treatment-naive or on bisphosphonate treatment.” – by Amber Cox
Disclosures: Geusens reports he receives research support, consultant and/or speaker fees from Abbott, Amgen, Bristol-Myers Squibb, Lilly, Merck Sharp & Dohme, Novartis, Pfizer and UCB. Please see the study for all other authors’ relevant financial disclosures.
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