Four-Year Teriparatide Followed By Denosumab Vs. Continuous Denosumab In Glucocorticoid-Induced Osteoporosis Patients With Prior Bisphosphonate Treatment

ObjectivesIn our previous 24-month study, we observed that teriparatide had some advantages over denosumab for bone mineral density (BMD) in glucocorticoid-induced osteoporosis (GIO) patients with prior bisphosphonate treatment. We conducted this extension study to investigate whether the advantage of teriparatide obtained in the first 2 years would be maintained after the switch to denosumab.

Materials and MethodsWe switched patients who had completed 24-month daily teriparatide treatment to denosumab (switch group, n=18) and compared their BMD every 6 months up to 48 months with the group who continued to receive denosumab (denosumab group, n=16).

ResultsAt 48 months, the lumbar spine BMD was significantly increased from baseline in both groups (denosumab: 10.4 +/- 8.7%, p<0.001; switch: 14.2 +/- 6.8%, p<0.001). However, a significant increase in femoral neck BMD from baseline occurred only in the switch group (11.2 +/- 14.6%, p<0.05); denosumab (4.1 +/- 10.8%). The total hip BMD increased significantly from baseline in both groups (denosumab: 4.60 +/- 7.4%, p<0.05; switch: 7.2 +/- 6.9%, p<0.01). Femoral neck BMD was significantly increased in the switch versus the denosumab group (p<0.05).

ConclusionIn GIO patients with prior bisphosphonate treatment, the advantage of teriparatide may be maintained after the treatment period. A continuous increase in BMD can be expected with teriparatide followed by denosumab.