Standard Versus Cyclic Teriparatide and Denosumab Treatment for Osteoporosis: A Randomized Trial

ABSTRACT In the absence of an intervening antiresorptive agent, cyclic administration of teriparatide does not increase bone mineral density (BMD) more than standard daily therapy. Because denosumab is a potent antiresorptive agent with a rapid off‐effect, we hypothesized that it might be the optima...

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Published in:Journal of bone and mineral research 2020-02, Vol.35 (2), p.219-225
Main Authors: Cosman, Felicia, McMahon, Donald, Dempster, David, Nieves, Jeri W
Format: Article
Language:English
Subjects:
ANABOLIC
ANTIRESORPTIVE
Bone mineral density
DENOSUMAB
Dual energy X-ray absorptiometry
Hip
Immunotherapy
Monoclonal antibodies
Osteoporosis
Parathyroid hormone
Post-menopause
Radius
SEQUENTIAL
Spine (lumbar)
TERIPARATIDE
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container_title Journal of bone and mineral research
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creator Cosman, Felicia
McMahon, Donald
Dempster, David
Nieves, Jeri W
description ABSTRACT In the absence of an intervening antiresorptive agent, cyclic administration of teriparatide does not increase bone mineral density (BMD) more than standard daily therapy. Because denosumab is a potent antiresorptive agent with a rapid off‐effect, we hypothesized that it might be the optimal agent to help maximize bone gains with cyclic teriparatide. In this 3‐year protocol, 70 postmenopausal women with osteoporosis were randomized to 18 months of teriparatide followed by 18 months of denosumab (standard) or three separate 12‐month cycles of 6 months of teriparatide followed by 6 months of denosumab (cyclic). BMD (dual‐energy X‐ray absorptiometry [DXA]) measurements of lumbar spine (LS), total hip (TH), femoral neck (FN), and 1/3 radius (RAD) were performed every 6 months and total body bone mineral (TBBM) at 18 and 36 months. Baseline descriptive characteristics did not differ between groups except for a minimal difference in LS BMD but not T‐score (mean age 65 years, mean LS T‐score − 2.7). In the standard group, BMD increments at 36 months were: LS 16%, TH 4%, FN 3%, and TBBM 4.8% (all p 
doi_str_mv 10.1002/jbmr.3850
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Because denosumab is a potent antiresorptive agent with a rapid off‐effect, we hypothesized that it might be the optimal agent to help maximize bone gains with cyclic teriparatide. In this 3‐year protocol, 70 postmenopausal women with osteoporosis were randomized to 18 months of teriparatide followed by 18 months of denosumab (standard) or three separate 12‐month cycles of 6 months of teriparatide followed by 6 months of denosumab (cyclic). BMD (dual‐energy X‐ray absorptiometry [DXA]) measurements of lumbar spine (LS), total hip (TH), femoral neck (FN), and 1/3 radius (RAD) were performed every 6 months and total body bone mineral (TBBM) at 18 and 36 months. Baseline descriptive characteristics did not differ between groups except for a minimal difference in LS BMD but not T‐score (mean age 65 years, mean LS T‐score − 2.7). In the standard group, BMD increments at 36 months were: LS 16%, TH 4%, FN 3%, and TBBM 4.8% (all p &lt; 0.001 versus baseline). 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subjects ANABOLIC
ANTIRESORPTIVE
Bone mineral density
DENOSUMAB
Dual energy X-ray absorptiometry
Hip
Immunotherapy
Monoclonal antibodies
Osteoporosis
Parathyroid hormone
Post-menopause
Radius
SEQUENTIAL
Spine (lumbar)
TERIPARATIDE
title Standard Versus Cyclic Teriparatide and Denosumab Treatment for Osteoporosis: A Randomized Trial
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