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

J Clin Endocrinol Metab. 2019 Jul 02;: Authors: Lyu H, Zhao SS, Yoshida K, Tedeschi SK, Xu C, Nigwekar SU, Leder BZ, Solomon DH

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 [PubMed - as supplied by publisher]

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