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J Clin Endocrinol Metab. 2019 Jul 2. pii: jc.2019-00924. doi: 10.1210/jc.2019-00924. [Epub ahead of print]

Comparison of Teriparatide and Denosumab in Patients Switching from Long-Term Bisphosphonate Use.

Author information

1
China National Clinical Research Center of Musculoskeletal Diseases, Beijing, China.
2
Department of Orthopedics, Chinese PLA General Hospital, Beijing, China.
3
Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States.
4
Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, Massachusetts, United States.
5
Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK.
6
Departments of Epidemiology and Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States.
7
Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States.
8
Endocrine Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States.
9
Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, United States.

Abstract

CONTEXT:

Teriparatide and denosumab are effective treatments for osteoporosis and typically reserved as second-line options after patients have used bisphosphonates. However, limited head-to-head comparative effectiveness data exist between teriparatide and denosumab.

OBJECTIVE:

We compared changes in bone mineral density (BMD) between groups treated with teriparatide or denosumab after using bisphosphonates, focusing on the change in BMD while on either drug over 2 years.

DESIGN:

Observational cohort study using electronic medical records from two academic medical centers in the US.

PARTICIPANTS:

The study population included osteoporotic patients > 45 years who received bisphosphonates over one year prior to switching to teriparatide or denosumab.

OUTCOME MEASURES:

Annualized BMD change from baseline at the lumbar spine, total hip and femoral neck.

RESULTS:

Patients treated with teriparatide (n=110) were compared to those treated with denosumab (n=105); the mean (SD) age was 70 (10) years and median duration (IQR) of bisphosphonate use was 7.0 (5.6-9.7) years. Compared to denosumab users, teriparatide users had higher annualized BMD change at the spine by 1.3% (95% CI 0.02, 2.7%), but lower at the total hip by -2.2% (95% CI -2.9 to -1.5%) and the femoral neck by -1.1% (95% CI -2.1 to -0.1%). Those who switched to teriparatide had a transient loss of hip BMD for the first year, with no overall increase in the total hip BMD over two years.

CONCLUSIONS:

Among patients who use long-term bisphosphonates, the decision of switching to teriparatide should be made with caution, especially for patients at high risk of hip fracture.

PMID:
31265071
DOI:
10.1210/jc.2019-00924

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