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Once the clock runs out on teriparatide (TPTD or Forteo), what is the next best option?
A one-year observational study compared switching from daily TPTD to either oral bisphosphonates (BP) therapy or denosumab (DMAb) in patients with primary osteoporosis. Postmenopausal patients (n=78) with a mean age 76.3 years, had taken TPTD therapy for 20.1 (6-24) months were allocated to either the BP or DMAb groups based on physician's decision. BMD and serum bone turnover markers were monitored every 6 months.
Groups were well matched at baseline and after 12 months. The increase in BMD was significantly greater in the switch-to-DMAb group compared to the switch-to-BP group: lumbar spine (6.2 vs. 2.6%; P<0.01), total hip (4.2 vs. 1.1%; P<0.05), and femoral neck (3.5 vs. 1.4%; P<0.05). The DMAb group showed a significant decrease in some bone turnover markers (TRACP-5b [-55.8 vs. -32.8%; P<0.01] and ucOC [-85.5 vs. -65.0%; P<0.001], but not PINP (-67.5 vs. -62.1%).
In this open-label observational study, switching daily TPTD to DMAb significantly increased BMD and decreased bone resorption markers compared to switching to oral BP at 12 months, and thus may next best option after daily TPTD treatment.