J Clin Endocrinol Metab. 2022 Apr 16:dgac232. doi: 10.1210/clinem/dgac232. Online ahead of print.
ABSTRACT
CONTEXT: Premenopausal women with idiopathic osteoporosis (PreMenIOP) have marked deficits in bone density, microstructure and strength.
OBJECTIVE: To define effects of treatment with teriparatide followed by denosumab on Lumbar Spine (LS) volumetric BMD (vBMD) and stiffness by finite element analysis assessed on central QCT (cQCT) scans.
DESIGN, SETTINGS AND PARTICIPANTS: Ancillary analysis of baseline, post-teriparatide and post-denosumab cQCT scans from a randomized trial of 41 women allocated to teriparatide (20 mcg daily; N=28) or placebo (N=11). After 6 months (M), those on teriparatide continued for 18M and those on placebo switched to teriparatide for 24M. After completing teriparatide, 33 enrolled in a phase 2B extension with denosumab (60mg q6M) for 12M.
MAIN OUTCOME MEASURES: Primary outcomes were percent change from baseline in LS trabecular vBMD and stiffness after teriparatide, and between end of teriparatide and completing denosumab. Percent change from baseline in LS trabecular vBMD and stiffness after sequential teriparatide and denosumab were secondary outcomes.
FINDINGS: There were large increases (all p<0.001) in trabecular vBMD (25%), other vBMD parameters, and stiffness (21%) after teriparatide. Statistically significant increases in trabecular vBMD (10%; p<0.001) and other vBMD parameters (p=0.03-0.001) were seen after denosumab, while stiffness increased by 7% (p=0.068). Sequential teriparatide and denosumab led to highly significant (all p<0.001) increases LS trabecular vBMD (43%), other vBMD parameters (15-31%) and stiffness (21%).
CONCLUSIONS: The large and statistically significant increases in volumetric density and stiffness after sequential treatment with teriparatide followed by denosumab are encouraging and support use of this regimen in PreMenIOP.
PMID:35428889 | DOI:10.1210/clinem/dgac232
