Background: Osteoporosis has a significant morbidity and mortality burden. In Australia, antiresorptive medication is first line and PBS criteria limit accessibility to the anabolic agent Teriparatide.
Aims: To quantify the real-world effectiveness of 18 month teriparatide treatment in a clinical cohort. Secondary aims include (1) analysis of clinical characteristics that predict BMD improvement; (2) comparison of teriparatide cohort (TP) to a matched teriparatide-naïve cohort (control cohort CT) and assessment of follow up fracture rates.
Methods: Analysis of a retrospective cohort was performed utilising a database of DEXA scans performed on Hologic/Lunar scanners at RNSH in Sydney. EMR data was collected and analysed for 115 patients. 54 patients met the inclusion criteria for the TP cohort; receiving 18-24 months of teriparatide at RNSH from 2010-2022. A BMD-matched cohort of 61 patients was conceived as the CT, which had similar baseline T-scores but were teriparatide-naïve and primarily treated with bisphosphonates or denosumab between 2017-2022.
Results: Mean BMD increase in the TP cohort was associated with a statistically significant improvement of 5.99% at the lumbar spine and 2.04% at the total hip (p<0.05). The CT cohort similarly showed BMD improvements at only the lumbar spine and total hip of 6.47% and 4.39%, respectively (p<0.001). There were no statistically significant differences between the TP and CT cohorts (p>0.05). We were unable to predict BMD changes based on demographic and clinical characteristics. At one-year follow up, 11.11% of the TP cohort and 8.20% of the CT cohort had refractured, with no difference between groups (p>0.05).
Conclusions: This study showed that teriparatide has no benefit over a matched cohort treated with primarily bisphosphonates or denosumab. This may reflect that the current osteoporosis treatment sequence in Australia may require refinement.