Combination or sequential teriparatide for osteoporosis treatment in denosumab-users: real-world bone mineral density outcomes
The optimal osteoanabolic strategy in denosumab (Dmab)-users remains uncertain. In treatment-naïve patients, Dmab/teriparatide (TPTD) combinations result in dramatic bone mineral density (BMD) gains at the spine and hip. However, BMD outcomes with combination Dmab/TPTD have not been investigated in...
Saved in:
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-06-01
|
| Series: | Bone Reports |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352187225000245 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850103438471331840 |
|---|---|
| author | Shejil KUMAR Courtney STREETER Michelle M. MCDONALD Roderick J. CLIFTON- BLIGH Matti L. GILD Christian M. GIRGIS |
| author_facet | Shejil KUMAR Courtney STREETER Michelle M. MCDONALD Roderick J. CLIFTON- BLIGH Matti L. GILD Christian M. GIRGIS |
| author_sort | Shejil KUMAR |
| collection | DOAJ |
| description | The optimal osteoanabolic strategy in denosumab (Dmab)-users remains uncertain. In treatment-naïve patients, Dmab/teriparatide (TPTD) combinations result in dramatic bone mineral density (BMD) gains at the spine and hip. However, BMD outcomes with combination Dmab/TPTD have not been investigated in patients on established Dmab.We retrospectively reviewed patients with osteoporosis at two Sydney centers between 2013 and 2023. Eligible patients were managed with Dmab immediately before ≥12-months TPTD. Patients were grouped according to whether TPTD was added to ongoing Dmab (combination) or Dmab was withheld during TPTD (sequence). BMD outcomes were assessed during TPTD.The total cohort (N = 23; 11 = combination, 12 = sequence) had mean age 77 ± 7 years and were predominantly female (87 %). Overall, prior vertebral (52 %) and non-vertebral fractures (2.4 ± 1.5) were prevalent and pre-TPTD BMD T-scores (SD) low at lumbar spine (−2.4 ± 1.2) and total hip (−2.2 ± 0.6). Median Dmab exposure was 5-doses (IQR 3–11), median overall antiresorptive exposure was 6-years (IQR 4–11) and majority (>90 %) received 18-months TPTD. Groups were similar in age, sex, Dmab and overall antiresorptive exposure, fracture prevalence, DXA interval and pre-TPTD BMD values. Combination Dmab/TPTD was associated with significant lumbar spine BMD gains (+0.080 g/cm2 ± 0.059 g/cm2, p = 0.004; +9.8 %). No significant BMD change occurred during sequential Dmab/TPTD (+0.026 g/cm2 ± 0.049 g/cm2, p = 0.107; +3.5 %). Combination Dmab/TPTD resulted in greater lumbar spine BMD gains (p = 0.039). Hip and femoral neck BMD remained stable in both groups.In this retrospective study, significant lumbar spine BMD gains occurred during combined Dmab/TPTD in patients on established Dmab. These results warrant prospective controlled studies to further inform optimal osteoanabolic strategies in Dmab-users. |
| format | Article |
| id | doaj-art-e87ded8d4531426a8b0f62888f6c8d11 |
| institution | DOAJ |
| issn | 2352-1872 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Bone Reports |
| spelling | doaj-art-e87ded8d4531426a8b0f62888f6c8d112025-08-20T02:39:33ZengElsevierBone Reports2352-18722025-06-012510184710.1016/j.bonr.2025.101847Combination or sequential teriparatide for osteoporosis treatment in denosumab-users: real-world bone mineral density outcomesShejil KUMAR0Courtney STREETER1Michelle M. MCDONALD2Roderick J. CLIFTON- BLIGH3Matti L. GILD4Christian M. GIRGIS5Department of Endocrinology, Royal North Shore Hospital, Sydney, Australia; Faculty of Medicine & Health, The University of Sydney, Sydney, Australia; Department of Endocrinology, Westmead Hospital, Sydney, Australia; Corresponding author at: Department of Endocrinology, Royal North Shore Hospital, Reserve Rd, Sydney 2065, NSW, Australia.Faculty of Medicine & Health, The University of Sydney, Sydney, AustraliaFaculty of Medicine & Health, The University of Sydney, Sydney, Australia; Faculty of Medicine, University of New South Wales, Sydney, Australia; Bone Biology Program, Garvan Institute of Medical Research, Sydney, AustraliaDepartment of Endocrinology, Royal North Shore Hospital, Sydney, Australia; Faculty of Medicine & Health, The University of Sydney, Sydney, Australia; Kolling Institute of Medical Research, Sydney, AustraliaDepartment of Endocrinology, Royal North Shore Hospital, Sydney, Australia; Faculty of Medicine & Health, The University of Sydney, Sydney, Australia; Kolling Institute of Medical Research, Sydney, AustraliaFaculty of Medicine & Health, The University of Sydney, Sydney, Australia; Department of Endocrinology, Westmead Hospital, Sydney, AustraliaThe optimal osteoanabolic strategy in denosumab (Dmab)-users remains uncertain. In treatment-naïve patients, Dmab/teriparatide (TPTD) combinations result in dramatic bone mineral density (BMD) gains at the spine and hip. However, BMD outcomes with combination Dmab/TPTD have not been investigated in patients on established Dmab.We retrospectively reviewed patients with osteoporosis at two Sydney centers between 2013 and 2023. Eligible patients were managed with Dmab immediately before ≥12-months TPTD. Patients were grouped according to whether TPTD was added to ongoing Dmab (combination) or Dmab was withheld during TPTD (sequence). BMD outcomes were assessed during TPTD.The total cohort (N = 23; 11 = combination, 12 = sequence) had mean age 77 ± 7 years and were predominantly female (87 %). Overall, prior vertebral (52 %) and non-vertebral fractures (2.4 ± 1.5) were prevalent and pre-TPTD BMD T-scores (SD) low at lumbar spine (−2.4 ± 1.2) and total hip (−2.2 ± 0.6). Median Dmab exposure was 5-doses (IQR 3–11), median overall antiresorptive exposure was 6-years (IQR 4–11) and majority (>90 %) received 18-months TPTD. Groups were similar in age, sex, Dmab and overall antiresorptive exposure, fracture prevalence, DXA interval and pre-TPTD BMD values. Combination Dmab/TPTD was associated with significant lumbar spine BMD gains (+0.080 g/cm2 ± 0.059 g/cm2, p = 0.004; +9.8 %). No significant BMD change occurred during sequential Dmab/TPTD (+0.026 g/cm2 ± 0.049 g/cm2, p = 0.107; +3.5 %). Combination Dmab/TPTD resulted in greater lumbar spine BMD gains (p = 0.039). Hip and femoral neck BMD remained stable in both groups.In this retrospective study, significant lumbar spine BMD gains occurred during combined Dmab/TPTD in patients on established Dmab. These results warrant prospective controlled studies to further inform optimal osteoanabolic strategies in Dmab-users.http://www.sciencedirect.com/science/article/pii/S2352187225000245TeriparatideDenosumabOsteoporosisBone mineral densityCombinationSequence |
| spellingShingle | Shejil KUMAR Courtney STREETER Michelle M. MCDONALD Roderick J. CLIFTON- BLIGH Matti L. GILD Christian M. GIRGIS Combination or sequential teriparatide for osteoporosis treatment in denosumab-users: real-world bone mineral density outcomes Bone Reports Teriparatide Denosumab Osteoporosis Bone mineral density Combination Sequence |
| title | Combination or sequential teriparatide for osteoporosis treatment in denosumab-users: real-world bone mineral density outcomes |
| title_full | Combination or sequential teriparatide for osteoporosis treatment in denosumab-users: real-world bone mineral density outcomes |
| title_fullStr | Combination or sequential teriparatide for osteoporosis treatment in denosumab-users: real-world bone mineral density outcomes |
| title_full_unstemmed | Combination or sequential teriparatide for osteoporosis treatment in denosumab-users: real-world bone mineral density outcomes |
| title_short | Combination or sequential teriparatide for osteoporosis treatment in denosumab-users: real-world bone mineral density outcomes |
| title_sort | combination or sequential teriparatide for osteoporosis treatment in denosumab users real world bone mineral density outcomes |
| topic | Teriparatide Denosumab Osteoporosis Bone mineral density Combination Sequence |
| url | http://www.sciencedirect.com/science/article/pii/S2352187225000245 |
| work_keys_str_mv | AT shejilkumar combinationorsequentialteriparatideforosteoporosistreatmentindenosumabusersrealworldbonemineraldensityoutcomes AT courtneystreeter combinationorsequentialteriparatideforosteoporosistreatmentindenosumabusersrealworldbonemineraldensityoutcomes AT michellemmcdonald combinationorsequentialteriparatideforosteoporosistreatmentindenosumabusersrealworldbonemineraldensityoutcomes AT roderickjcliftonbligh combinationorsequentialteriparatideforosteoporosistreatmentindenosumabusersrealworldbonemineraldensityoutcomes AT mattilgild combinationorsequentialteriparatideforosteoporosistreatmentindenosumabusersrealworldbonemineraldensityoutcomes AT christianmgirgis combinationorsequentialteriparatideforosteoporosistreatmentindenosumabusersrealworldbonemineraldensityoutcomes |