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Efficacy of teriparatide compared with risedronate on FRAX®-defined major osteoporotic fractures: results of the VERO clinical trial.
Osteoporos Int. 2020 Oct; 31(10):1935-1942.OI

Abstract

FRAX® calculates the 10-year probability of major osteoporotic fractures (MOF), which are considered to have a greater clinical impact than other fractures. Our results suggest that, in postmenopausal women with severe osteoporosis, those treated with teriparatide had a 60% lower risk of FRAX®-defined MOF compared with those treated with risedronate.

INTRODUCTION

The VERO trial was an active-controlled fracture endpoint clinical trial that enrolled postmenopausal women with severe osteoporosis. After 24 months, a 52% reduction in the hazard ratio (HR) of clinical fractures was reported in patients randomized to teriparatide compared with risedronate. We examined fracture results restricted to FRAX®-defined major osteoporotic fractures (MOF), which include clinical vertebral, hip, humerus, and forearm fractures.

METHODS

In total, 1360 postmenopausal women (mean age 72.1 years) were randomized to receive subcutaneous daily teriparatide (20 μg) or oral weekly risedronate (35 mg). Patient cumulative incidence of ≥ 1 FRAX®-defined MOF and of all clinical fractures were estimated by Kaplan-Meier analyses, and the comparison between treatments was based on the stratified log-rank test. Additionally, an extended Cox model was used to estimate HRs at different time points. Incidence fracture rates were estimated at each 6-month interval.

RESULTS

After 24 months, 16 (2.6%) patients in the teriparatide group had ≥ 1 low trauma FRAX®-defined MOF compared with 40 patients (6.4%) in the risedronate group (HR 0.40; 95% CI 0.23-0.68; p = 0.001). Clinical vertebral and radius fractures were the most frequent FRAX®-defined MOF sites. The largest difference in incidence rates of both FRAX®-defined MOF and all clinical fractures between treatments occurred during the 6- to 12-month period. There was a statistically significant reduction in fractures between groups as early as 7 months for both categories of clinical fractures analyzed.

CONCLUSION

In postmenopausal women with severe osteoporosis, treatment with teriparatide was more efficacious than risedronate, with a 60% lower risk of FRAX®-defined MOF during the 24-month treatment period. Fracture risk was statistically significantly reduced at 7 months of treatment.

CLINICAL TRIAL INFORMATION

ClinicalTrials.gov Identifier: NCT01709110 EudraCT Number: 2012-000123-41.

Authors+Show Affiliations

CHU Brugmann, Université Libre de Bruxelles (ULB), Brussels, Belgium. jean-jacques.body@chu-brugmann.be.Lilly Research Center Europe, Madrid, Spain.University of British Columbia, Vancouver, Canada.Centro Paulista de Investigaçao Clínica, Sao Paulo, Brazil.Lilly Research Center Europe, Madrid, Spain.Institut Präventive Medizin & Klinische Forschung, Magdeburg, Germany.University Hospital Parc Taulí Sabadell, Barcelona, Spain.Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria.Institute of Rheumatology and Faculty of Medicine 1, Charles University, Prague, Czech Republic.Regional Hospital, University of Orleans, Orleans, France.Sapienza Rome University, Rome, Italy.Maastricht University Medical Center, Maastricht, The Netherlands.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32474650

Citation

Body, J-J, et al. "Efficacy of Teriparatide Compared With Risedronate On FRAX®-defined Major Osteoporotic Fractures: Results of the VERO Clinical Trial." Osteoporosis International : a Journal Established as Result of Cooperation Between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, vol. 31, no. 10, 2020, pp. 1935-1942.
Body JJ, Marin F, Kendler DL, et al. Efficacy of teriparatide compared with risedronate on FRAX®-defined major osteoporotic fractures: results of the VERO clinical trial. Osteoporos Int. 2020;31(10):1935-1942.
Body, J. J., Marin, F., Kendler, D. L., Zerbini, C. A. F., López-Romero, P., Möricke, R., Casado, E., Fahrleitner-Pammer, A., Stepan, J. J., Lespessailles, E., Minisola, S., & Geusens, P. (2020). Efficacy of teriparatide compared with risedronate on FRAX®-defined major osteoporotic fractures: results of the VERO clinical trial. Osteoporosis International : a Journal Established as Result of Cooperation Between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 31(10), 1935-1942. https://doi.org/10.1007/s00198-020-05463-4
Body JJ, et al. Efficacy of Teriparatide Compared With Risedronate On FRAX®-defined Major Osteoporotic Fractures: Results of the VERO Clinical Trial. Osteoporos Int. 2020;31(10):1935-1942. PubMed PMID: 32474650.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Efficacy of teriparatide compared with risedronate on FRAX®-defined major osteoporotic fractures: results of the VERO clinical trial. AU - Body,J-J, AU - Marin,F, AU - Kendler,D L, AU - Zerbini,C A F, AU - López-Romero,P, AU - Möricke,R, AU - Casado,E, AU - Fahrleitner-Pammer,A, AU - Stepan,J J, AU - Lespessailles,E, AU - Minisola,S, AU - Geusens,P, Y1 - 2020/05/30/ PY - 2020/02/25/received PY - 2020/05/11/accepted PY - 2020/6/1/pubmed PY - 2021/3/4/medline PY - 2020/6/1/entrez KW - Bisphosphonates KW - FRAX® KW - Fractures KW - Osteoporosis KW - Risedronate KW - Teriparatide SP - 1935 EP - 1942 JF - Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA JO - Osteoporos Int VL - 31 IS - 10 N2 - : FRAX® calculates the 10-year probability of major osteoporotic fractures (MOF), which are considered to have a greater clinical impact than other fractures. Our results suggest that, in postmenopausal women with severe osteoporosis, those treated with teriparatide had a 60% lower risk of FRAX®-defined MOF compared with those treated with risedronate. INTRODUCTION: The VERO trial was an active-controlled fracture endpoint clinical trial that enrolled postmenopausal women with severe osteoporosis. After 24 months, a 52% reduction in the hazard ratio (HR) of clinical fractures was reported in patients randomized to teriparatide compared with risedronate. We examined fracture results restricted to FRAX®-defined major osteoporotic fractures (MOF), which include clinical vertebral, hip, humerus, and forearm fractures. METHODS: In total, 1360 postmenopausal women (mean age 72.1 years) were randomized to receive subcutaneous daily teriparatide (20 μg) or oral weekly risedronate (35 mg). Patient cumulative incidence of ≥ 1 FRAX®-defined MOF and of all clinical fractures were estimated by Kaplan-Meier analyses, and the comparison between treatments was based on the stratified log-rank test. Additionally, an extended Cox model was used to estimate HRs at different time points. Incidence fracture rates were estimated at each 6-month interval. RESULTS: After 24 months, 16 (2.6%) patients in the teriparatide group had ≥ 1 low trauma FRAX®-defined MOF compared with 40 patients (6.4%) in the risedronate group (HR 0.40; 95% CI 0.23-0.68; p = 0.001). Clinical vertebral and radius fractures were the most frequent FRAX®-defined MOF sites. The largest difference in incidence rates of both FRAX®-defined MOF and all clinical fractures between treatments occurred during the 6- to 12-month period. There was a statistically significant reduction in fractures between groups as early as 7 months for both categories of clinical fractures analyzed. CONCLUSION: In postmenopausal women with severe osteoporosis, treatment with teriparatide was more efficacious than risedronate, with a 60% lower risk of FRAX®-defined MOF during the 24-month treatment period. Fracture risk was statistically significantly reduced at 7 months of treatment. CLINICAL TRIAL INFORMATION: ClinicalTrials.gov Identifier: NCT01709110 EudraCT Number: 2012-000123-41. SN - 1433-2965 UR - https://www.unboundmedicine.com/medline/citation/32474650/Efficacy_of_teriparatide_compared_with_risedronate_on_FRAX®_defined_major_osteoporotic_fractures:_results_of_the_VERO_clinical_trial_ L2 - https://doi.org/10.1007/s00198-020-05463-4 DB - PRIME DP - Unbound Medicine ER -