Teriparatide in prior bisphosphonate users

Postmenopausal women with osteoporosis are at high risk for fractures and other complications, such as chronic back pain that reduces health-related quality of life (HRQoL). Osteoporosis treatment aims to reduce fracture risk and its associated burden. Bisphosphonates are routinely used as a first line of treatment in postmenopausal osteoporosis. Teriparatide (recombinant DNA origin human parathyroid hormone PTH 1-34) is typically used as a second-line of treatment in patients with severe osteoporosis who are at high risk for fracture. However, there is no published information about fracture risk and QoL after teriparatide treatment in patients pre-treated with bisphosphonates.

The European Forsteo Observational Study (EFOS) - a 36 month, prospective, observational study – was initiated soon after the European approval of teriparatide for the treatment of postmenopausal women with established osteoporosis at high risk for fracture. The study enrolled 1649 postmenopausal women with a diagnosis of established osteoporosis who, at the discretion of their physician, were about to initiate teriparatide treatment.

Jakob et al. describe clinical fracture outcomes, back pain, and HRQoL in the EFOS subgroup of postmenopausal women with osteoporosis previously treated with bisphosphonates. They describe outcomes both during treatment with teriparatide for up to 18 months and in the subsequent 18-month follow-up period after teriparatide was discontinued when most patients were receiving other osteoporosis medications to investigate a potential sustained effect after teriparatide treatment was stopped.

They study shows that postmenopausal women with severe osteoporosis previously treated with bisphosphonates had a significant reduction in the incidence of fractures compared with the first 6 months of therapy, a reduction in back pain and an improvement in HRQoL during up to 18 months of teriparatide treatment. These outcomes were still evident for at least 18 months after teriparatide was discontinued when the majority of patients were receiving other osteoporosis therapy. Jakob et al (2012) European Journal of Endocrinology 166 87-97.

Read the full article at DOI: 10.1530/EJE-11-0740