Real-World Data Show Reduced Fracture Rates in Teriparatide-Treated Osteoporosis

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Rates of incident clinical vertebral fracture, incident nonvertebral fracture, hip fracture, and clinical fractures decreased 6 months after initiation of teriparatide.

In patients with osteoporosis treated with teriparatide, rates of incident clinical vertebral fracture (CVF), incident nonvertebral fracture (NVF), hip fracture, and clinical fractures decreased 6 months after initiation of therapy, according to data from 4 real-world observational studies published in the journal Bone.

Patients were treated with teriparatide 20 μg/day for up to 24 months. Fracture rates were compared between 0 and 6 months vs >6 months after the onset of teriparatide treatment. Analyses of fracture rates were performed in subgroups based on age <75 years or >75 years, gender, presence of diabetes, presence of rheumatoid arthritis (RA), prior bisphosphonate use, glucocorticoid use, prior VF, and prior hip fracture.

A total of 8828 patients were included, of whom 8117 were women. The mean patient age was 71 ± 10.6 years and the mean teriparatide treatment duration was 17.4 ± 8.6 months. Rates of CVF, NVF, clinical fracture, and hip fracture decreased by 62%, 43%, 50%, and 56%, respectively, at >6 months vs 0 to 6 months (P < .05 for all). Subgroup analyses revealed decreased rates were reported after >6 months except for CVF in patients with prior hip fracture and NVF reduction in men and in patients treated with glucocorticoids.

Furthermore, the effects of teriparatide on NVF, CVF, and clinical fractures over time were statistically significant in all subgroups except age for CVF (P =.074, with patients <75 years responding better than those >75 years) and diabetes for clinical fracture (P =.046, with patients with diabetes responding better than those without diabetes). All of these subgroups, however, did experience significant reductions in fracture over time.

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Prior bisphosphonate use, glucocorticoids, and prior VF were all associated with increased CVF, NVF, and clinical fracture rates. Additionally, prior hip fracture, the presence of RA, and female sex were associated with higher NVF and clinical fracture rates. Moreover, older age was associated with elevated CVF and clinical fracture rates.

The investigators concluded that the results of these analyses should be interpreted in the context of the noncontrolled design of the source studies, which were conducted in real-world populations. According to these results, the use of teriparatide is efficacious in patients with a variety of preexisting conditions.

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Langdahl BL, Silverman S, Fujiwara S, et al. Real-world effectiveness of teriparatide on fracture reduction in patients with osteoporosis and comorbidities or risk factors for fractures: Integrated analysis of 4 prospective observational studies. Bone. 2018;116:58-66.