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Cosman F, Langdahl B, Leder BZ. Treatment Sequence for Osteoporosis. Endocr Pract 2024; 30:490-496. [PMID: 38311211 DOI: 10.1016/j.eprac.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 01/22/2024] [Accepted: 01/26/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Osteoporosis is a chronic progressive disease that requires lifelong monitoring and treatment. Sequencing from one treatment to another at different ages and stages of disease is an approach that can maximize benefits and avoid potential risks from long-term treatment with a single agent. OBJECTIVE This article reviews clinical trial data in postmenopausal women that evaluate the effects of antiresorptive agents followed by other antiresorptives, osteoanabolic agents followed by antiresorptives, and antiresorptives followed by osteoanabolic medications. METHODS Literature review and discussion. RESULTS When medications are discontinued, in the absence of sequential therapy, bone turnover rates return to baseline or above baseline, and bone loss occurs. The rate of bone loss differs for different treatments, with a very slow decline after stopping bisphosphonates and a particularly rapid decline after stopping denosumab. Careful attention to osteoporosis medication transitions can mitigate bone density loss and its consequences. For women who remain at high risk, switching from bisphosphonates to the more potent antiresorptive, denosumab, will result in further improvement in bone mineral density (BMD). When indicated, stopping denosumab can be accomplished safely by transition to an adequate bisphosphonate regimen. For high- and very-high-risk patients, treating with osteoanabolic agents first, followed by antiresorptive agents, produces substantially larger BMD gains than the reverse treatment sequence, with the biggest differences seen for BMD of the hip. CONCLUSION Awareness of the importance of treatment sequences can help improve osteoporosis care across the postmenopausal lifespan.
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Affiliation(s)
- Felicia Cosman
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York.
| | - Bente Langdahl
- Department of Endocrinology and Metabolic Bone Diseases, Aarhus University Hospital and Aarhus University, Aarhus, Denmark.
| | - Benjamin Z Leder
- Department of Medicine, Harvard Medical School, Endocrine Unit, Massachusetts General Hospital, Boston, Massachusetts.
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Tripto-Shkolnik L, Szalat A, Tsvetov G, Rouach V, Sternberg C, Hoppe A, Burshtein G, Galitzer H, Toledano M, Harari G, Santora AC, Cosman F. Oral daily PTH(1-34) tablets (EB613) in postmenopausal women with low BMD or osteoporosis: a randomized, placebo-controlled, six-month, phase 2 study. J Bone Miner Res 2024:zjae057. [PMID: 38578978 DOI: 10.1093/jbmr/zjae057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 02/21/2024] [Accepted: 04/03/2024] [Indexed: 04/07/2024]
Abstract
Anabolic treatment is indicated for high and very-high risk patients with osteoporosis, but acceptance is limited because current anabolic medications require subcutaneous injections. The purpose of this study was to assess the effects of a novel orally administered parathyroid hormone (PTH) tablet on serum markers of bone formation [N-terminal propeptide of Type I procollagen (PINP) and osteocalcin (OC)] and bone resorption [crosslinked C-telopeptide (CTX)], bone mineral density (BMD) and safety in postmenopausal women with low BMD or osteoporosis. In this 6-month, double-blind, placebo-controlled study, 161 patients were randomized to oral PTH tablets containing 0.5, 1.0, 1.5, or 2.5 mg or placebo daily. Biochemical markers were assessed at 1, 2, 3 and 6 months and BMD of lumbar spine, total hip and femoral neck was measured at 6 months. Biochemical marker changes were dose dependent with minimal or no effect at the two lowest doses. At the highest dose (2.5 mg once daily), serum PINP and OC levels increased 30% within 1 month after oral PTH initiation (p < 0.0001), remained elevated through 3 months and were back to baseline at 6 months. In contrast, serum CTX levels declined 16% and 21% below baseline at 3 and 6 months respectively (both p ≤ 0.02). At 6 months, 2.5 mg tablets increased mean BMD vs placebo of the lumbar spine by 2.7%, total hip by 1.8%, and femoral neck by 2.8% (all p ≤ 0.01). There were no drug-related serious adverse events. The most common adverse events were headache, nausea, and dizziness. In contrast to subcutaneous PTH, the oral PTH tablet appears to increase BMD rapidly by the dual mechanism of stimulating formation and inhibiting bone resorption. This might be the first effective oral anabolic alternative to subcutaneous administration for the treatment of low BMD or osteoporosis.
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Lane J, Langdahl B, Stone M, Kurth A, Oates M, Timoshanko J, Wang Z, Libanati C, Cosman F. Romosozumab in patients who experienced an on-study fracture: post hoc analyses of the FRAME and ARCH phase 3 trials. Osteoporos Int 2024:10.1007/s00198-024-07049-w. [PMID: 38573517 DOI: 10.1007/s00198-024-07049-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 02/28/2024] [Indexed: 04/05/2024]
Abstract
Post hoc analysis of FRAME and ARCH revealed that on-study nonvertebral and vertebral fractures by Month 12 were less common in women initially treated with romosozumab versus placebo or alendronate. Recurrent fracture risk was also lower in romosozumab‑treated patients, and there were no fracture‑related complications. Results support continuing romosozumab treatment post‑fracture. PURPOSE Post hoc analysis evaluating efficacy and safety of romosozumab, administered in the immediate post‑fracture period, in the FRAME and ARCH phase 3 trials. METHODS In FRAME (NCT01575834) and ARCH (NCT01631214), postmenopausal women with osteoporosis were randomized 1:1 to romosozumab 210 mg monthly or comparator (FRAME, placebo; ARCH, alendronate 70 mg weekly) for 12 months, followed by antiresorptive therapy (FRAME, denosumab; ARCH, alendronate). In patients who experienced on-study nonvertebral or new/worsening vertebral fracture by Month 12, we report the following: fracture and treatment‑emergent adverse event (TEAE) incidence through 36 months, bone mineral density changes (BMD), and romosozumab timing. Due to the sample sizes employed, meaningful statistical comparisons between treatments were not possible. RESULTS Incidence of on-study nonvertebral and vertebral fractures by Month 12 was numerically lower in romosozumab- versus comparator-treated patients (FRAME, 1.6% and 0.5% versus 2.1% and 1.6%; ARCH, 3.4% and 3.3% versus 4.6% and 4.9%, respectively). In those who experienced on-study nonvertebral fracture by Month 12, recurrent nonvertebral and subsequent vertebral fracture incidences were numerically lower in patients initially treated with romosozumab versus comparator (FRAME, 3.6% [2/56] and 1.8% [1/56] versus 9.2% [7/76] and 3.9% [3/76]; ARCH, 10.0% [7/70] and 5.7% [4/70] versus 12.6% [12/95] and 8.4% [8/95], respectively). Among those with on-study vertebral fracture by Month 12, recurrent vertebral and subsequent nonvertebral fracture incidences were numerically lower with romosozumab versus comparator (FRAME, 0.0% [0/17] and 0.0% [0/17] versus 11.9% [7/59] and 8.5% [5/59]; ARCH, 9.0% [6/67] and 7.5% [5/67] versus 15.0% [15/100] and 16.0% [16/100], respectively). In patients with fracture by Month 12, no fracture‑related complications were reported in romosozumab-treated patients. BMD gains were numerically greater with romosozumab than comparators. CONCLUSION Data suggest support for the efficacy and safety of continuing romosozumab treatment following fracture. TRIAL REGISTRATIONS NCT01575834; NCT01631214.
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Affiliation(s)
- J Lane
- HSS Ambulatory Care Center, New York, NY, USA
| | - B Langdahl
- Aarhus University Hospital, Aarhus, Denmark
| | - M Stone
- University Hospital Llandough, Cardiff and Vale University Health Board, Cardiff, Wales
| | - A Kurth
- Department of Orthopaedic and Trauma Surgery Center for Orthopaedic and Trauma Surgery, Marienhaus Klinikum Mainz, Major Teaching Hospital, University Medicine Mainz, Mainz, Germany
| | - M Oates
- Amgen Inc, Thousand Oaks, CA, USA
| | | | - Z Wang
- Amgen Inc, Thousand Oaks, CA, USA
| | | | - F Cosman
- Columbia University, New York, NY, USA.
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Cosman F. Skin in the Game? J Bone Miner Res 2023; 38:1387-1388. [PMID: 37706244 DOI: 10.1002/jbmr.4908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 08/26/2023] [Indexed: 09/15/2023]
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McClung MR, Betah D, Deignan C, Shi Y, Timoshanko J, Cosman F. Romosozumab Efficacy in Postmenopausal Women With No Prior Fracture Who Fulfill Criteria for Very High Fracture Risk. Endocr Pract 2023; 29:716-722. [PMID: 37406858 DOI: 10.1016/j.eprac.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 06/27/2023] [Accepted: 06/28/2023] [Indexed: 07/07/2023]
Abstract
OBJECTIVE We evaluated the efficacy of romosozumab in women from FRAME who had no prior fracture but met other criteria for very high fracture risk (VHFR). METHODS In FRAME, postmenopausal women received romosozumab or placebo for 12 months (year 1) followed by denosumab for 12 months (year 2). In this post hoc analysis, we applied the following criteria from the American Association of Clinical Endocrinology to define VHFR: lumbar spine or total hip T-score <-3.0 and/or Fracture Risk Assessment Tool probability of major osteoporotic fracture >30% or hip fracture >4.5% to women with no fracture history at baseline (no fracture-VHFR [NF-VHFR]). Incidence of new vertebral, clinical, and nonvertebral fractures and mean bone mineral density (BMD) percentage change from baseline were assessed at years 1 and 2. RESULTS Of the 7180 women in FRAME, 2825 were included in the NF-VHFR subgroup analysis. At year 1, romosozumab versus placebo reduced the incidence of new vertebral fracture (relative risk reduction [RRR]: 76%), clinical fracture (RRR: 60%), and nonvertebral fracture (RRR: 54%) (all P <.05). This fracture reduction was maintained through year 2 in women receiving the romosozumab-to-denosumab sequence versus the placebo-to-denosumab sequence for new vertebral, clinical, and nonvertebral fractures (RRR: 77%, 54%, and 46%, respectively; all P <.05). The mean BMD changes in both treatment groups were similar to those in the overall FRAME population at years 1 and 2. CONCLUSION Romosozumab significantly reduced vertebral, clinical, and nonvertebral fracture risk and increased the BMD more than placebo in women at VHFR.
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Affiliation(s)
- Michael R McClung
- Oregon Osteoporosis Center, Portland, Oregon; Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia.
| | | | | | - Yifei Shi
- Amgen Inc, Thousand Oaks, California
| | | | - Felicia Cosman
- Columbia University, College of Physicians and Surgeons, New York, New York
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Ganapathy A, Nieves JW, Keaveny TM, Cosman F. Effects of four-year cyclic versus two-year daily teriparatide treatment on volumetric bone density and bone strength in postmenopausal women with osteoporosis. Bone 2023; 167:116618. [PMID: 36410666 PMCID: PMC9822869 DOI: 10.1016/j.bone.2022.116618] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 07/23/2022] [Accepted: 11/16/2022] [Indexed: 11/23/2022]
Abstract
PURPOSE To evaluate the effects of cyclic vs daily teriparatide treatment (TPTD) on volumetric bone mineral density (vBMD) and bone strength at the hip and spine in women who were previously untreated. METHODS A total of 86 women were randomized to a 24-month open label treatment of either daily TPTD (20 μg daily) or cyclic TPTD (20 μg daily for 3 months followed by 3 months off). During a 2-year extension, women in the daily TPTD group were switched to alendronate (ALN) and those in the cyclic TPTD group continued on cyclic TPTD (without any ALN). QCT images were acquired at baseline, 2-years (n = 54) and 4-years (n = 35) and analyzed for volumetric integral, cortical and trabecular bone mineral density (vBMD) and bone strength (by finite element analysis) at the hip and spine. The primary analysis presented here compared the responses across equal total TPTD doses (2 years daily vs 4 years cyclic). RESULTS In the spine, integral vBMD and strength increased substantially after 2 years daily and 4 years cyclic TPTD, with no significant differences (vBMD +12 % vs +11 %, respectively, p = 0.70; spine strength +21 % vs +16 %, respectively, p = 0.35). At the hip, the gains were smaller, but again no significant differences were detected between the groups for the increases in either vBMD (+2 % in both groups, p = 0.97) or hip strength (3 % vs 3 %, p = 0.91). In the spine, the vBMD increment was about twice as large in the trabecular vs peripheral compartment; in the hip, significant vBMD gain was seen only in the trabecular compartment. CONCLUSIONS The gains in volumetric BMD and bone strength for an equivalent dose of TPTD did not depend on whether it was administered every day over two years or cyclically over four years.
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Affiliation(s)
- Aravinda Ganapathy
- Institute of Human Nutrition, Columbia University, New York, NY, United States of America
| | - Jeri W Nieves
- Department of Epidemiology and Institute of Human Nutrition, Columbia University, New York, NY, United States of America.
| | - Tony M Keaveny
- Departments of Mechanical Engineering and Bioengineering, University of California, Berkeley, CA, United States of America
| | - Felicia Cosman
- Department of Medicine, Columbia University, New York, NY, United States of America
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Cosman F, Hans D, Shevroja E, Wang Y, Mitlak B. Effect of Abaloparatide on Bone Microarchitecture Assessed by Trabecular Bone Score in Women With Osteoporosis: Post Hoc Analysis of ACTIVE and ACTIVExtend. J Bone Miner Res 2023; 38:464-470. [PMID: 36588166 DOI: 10.1002/jbmr.4764] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 12/12/2022] [Accepted: 12/29/2022] [Indexed: 01/03/2023]
Abstract
Although bone mineral density (BMD) is a predictor of fracture, many fractures occur in women with T-scores > -2.5. Bone microarchitecture, assessed by trabecular bone score (TBS), predicts fracture risk independent of BMD. We evaluated whether abaloparatide improves TBS and whether TBS trends were associated with vertebral fracture risk reduction. Women with osteoporosis randomized to abaloparatide or placebo for 18 months (ACTIVE), followed by alendronate for 24 months (ACTIVExtend), with evaluable TBS, were included in this post hoc analysis (N = 911). TBS was calculated from spine BMD scans using an algorithm adjusted for tissue thickness (TBSth ) at baseline, 6, 18, and 43 months. Mean increments in TBSth from baseline within and between treatment groups, proportion of women with TBSth increments above least significant change (LSC) and proportion with degraded TBSth (<1.027) were calculated. Risk estimates for vertebral fracture were compared using binary logistic regressions adjusted for baseline age and spine BMD. At baseline, 42% had degraded TBSth . Mean TBSth increased 4% after 18 months abaloparatide (p < 0.001) and was unchanged with placebo. After 2 subsequent years of alendronate, the total cumulative TBSth increase was 4.4% with abaloparatide/alendronate and 1.7% with placebo/alendronate (group difference, p < 0.001). At 43 months, the proportion of women with degraded TBSth had declined to 21% with abaloparatide/alendronate and 37% with placebo/alendronate (p < 0.05). An increase in TBSth ≥ LSC was observed in 50% of abaloparatide-treated women at 18 months and was associated with decreased odds (odds ratio [OR]; 95% confidence interval [CI]) of vertebral fracture (0.19; 95% CI, 0.04-0.80, 6 months; 0.30; 95% CI, 0.11-0.79, 43 months). In conclusion, abaloparatide increased TBSth rapidly and progressively over 18 months and increments were maintained over 2 years with alendronate. TBSth increase was associated with vertebral fracture risk reduction. Microarchitectural improvement may be one mechanism by which abaloparatide strengthens vertebral bone. © 2023 Radius Health, Inc and The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
| | - Didier Hans
- Interdisciplinary Center of Bone Diseases, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Enisa Shevroja
- Interdisciplinary Center of Bone Diseases, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Yamei Wang
- Radius Health, Inc., Boston, Massachusetts, USA
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Cosman F, Huang S, McDermott M, Cummings SR. Multiple Vertebral Fractures After Denosumab Discontinuation: FREEDOM and FREEDOM Extension Trials Additional Post Hoc Analyses. J Bone Miner Res 2022; 37:2112-2120. [PMID: 36088628 PMCID: PMC10092421 DOI: 10.1002/jbmr.4705] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 09/02/2022] [Accepted: 09/05/2022] [Indexed: 11/12/2022]
Abstract
It is uncertain whether the risk of vertebral fracture (VF) and multiple vertebral fractures (MVFs; ≥2 VFs) after denosumab (DMAb) discontinuation is related to treatment duration. A prior analysis of Fracture Reduction Evaluation of Denosumab in Osteoporosis Every 6 Months (FREEDOM) and FREEDOM Extension trials did not find a relationship with DMAb duration and may have underreported MVF incidence because it included women who did not have radiographs. In this post hoc exploratory analysis, the crude incidence and annualized rates of VF and MVF were determined in patients with ≥7 months' follow-up and ≥1 spine radiograph after discontinuing placebo or DMAb. A multivariate analysis was performed to identify predictors of MVF. Clinical characteristics of patients with ≥4 VFs were explored. This analysis included women who discontinued after placebo (n = 327) or DMAb either from FREEDOM or FREEDOM Extension (n = 425). The DMAb discontinuation group was subsequently dichotomized by treatment duration: short-term (≤3 years; n = 262) and long-term (>3 years; n = 213) treatment. For any VF, exposure-adjusted annualized rates per 100 patient-years (95% confidence interval [CI]) were 9.4 (95% CI, 6.4-13.4) for placebo, 6.7 (95% CI, 4.2-10.1) for short-term DMAb, and 10.7 (95% CI, 7.4-15) for long-term DMAb. Annualized rates for MVF were 3.6 (95% CI, 1.9-6.3), 2.9 (95% CI, 1.4-5.4), and 7.5 (95% CI, 4.8-11.1), respectively. Annualized rates for ≥4 VFs were 0.59 (95% CI, 0.1-2.1), 0.57 (95% CI, 0.1-2.1), and 3.34 (95% CI, 1.7-6.0), respectively. In a multivariate regression model, DMAb duration was significantly associated with MVF risk (odds ratio 3.0; 95% CI, 1.4-6.5). Of 15 patients with ≥4 VFs, 13 had DMAb exposure (mean ± standard deviation [SD], 4.9 ± 2.2 years). The risk of MVF after DMAb discontinuation increases with increased duration of DMAb treatment. Patients transitioning off DMAb after 3 years may warrant more frequent administration of zoledronic acid or another bisphosphonate to maintain bone turnover and bone mineral density (BMD) and prevent MVF. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Felicia Cosman
- Division of Endocrinology/Department of Medicine, Columbia University, New York, NY, USA
| | | | | | - Steven R Cummings
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute and University of California, San Francisco, CA, USA
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Cosman F, Cooper C, Wang Y, Mitlak B, Varughese S, Williams SA. Comparative effectiveness and cardiovascular safety of abaloparatide and teriparatide in postmenopausal women new to anabolic therapy: A US administrative claims database study. Osteoporos Int 2022; 33:1703-1714. [PMID: 35524068 PMCID: PMC9499892 DOI: 10.1007/s00198-022-06413-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 04/19/2022] [Indexed: 11/26/2022]
Abstract
Real-world evidence on the comparative effectiveness and safety of abaloparatide versus teriparatide in women with osteoporosis may help inform treatment decisions. Following 18 months of treatment, abaloparatide was comparable to teriparatide for prevention of nonvertebral fractures, resulted in a 22% risk reduction for hip fractures, and demonstrated similar cardiovascular safety. Osteoporotic fracture risk can be reduced with anabolic or antiresorptive medications. In addition to efficacy and safety data from controlled clinical trials, real-world evidence on comparative effectiveness and safety may help inform treatment decisions. INTRODUCTION The real-world effectiveness of abaloparatide versus teriparatide on nonvertebral fracture (NVF) incidence and cardiovascular safety during the 19-month period after treatment initiation were evaluated (NCT04974723). METHODS Anonymized US patient claims data from Symphony Health, Integrated Dataverse (IDV)®, May 1, 2017 to July 31, 2019, included women aged ≥ 50 years with ≥ 1 prescription of abaloparatide or teriparatide and no prior anabolic therapy. Most were enrolled in commercial and Medicare health plans. Index was the date of the initial prescription dispensed during the identification period. In 1:1 propensity score matched cohorts, time to first NVF following index date, major adverse cardiovascular events (MACE), and MACE + heart failure (HF) were compared between cohorts using a Cox proportional hazards model. RESULTS Propensity score matching yielded 11,616 patients per cohort. Overall median age (interquartile range) was 67 (61, 75) years, and 25.6% had a fracture history. Over 19 months, 335 patients on abaloparatide and 375 on teriparatide had a NVF (hazard ratio [95% confidence interval]: 0.89 [0.77, 1.03]), and 121 and 154 patients, respectively, had a hip fracture [HR (95% CI): 0.78 (0.62, 1.00)]. The MACE and MACE + HF rates were similar between cohorts. CONCLUSIONS Following 18 months of treatment, abaloparatide was comparable to teriparatide for prevention of NVF and similar cardiovascular safety was demonstrated between cohorts.
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Affiliation(s)
- F Cosman
- Department of Medicine, Columbia University, New York, NY, USA
| | - C Cooper
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Y Wang
- Biostatistics, Radius Health, Inc., Boston, MA, USA
| | - B Mitlak
- Clinical Development, Radius Health, Inc., Boston, MB, USA.
| | - S Varughese
- Pharmacovigilance, Radius Health, Inc., Boston, MA, USA
| | - S A Williams
- Global Health Economics and Outcomes Research, Radius Health, Inc., Boston, MA, USA
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Cosman F, Kendler DL, Langdahl BL, Leder BZ, Lewiecki EM, Miyauchi A, Rojeski M, McDermott M, Oates MK, Milmont CE, Libanati C, Ferrari S. Romosozumab and antiresorptive treatment: the importance of treatment sequence. Osteoporos Int 2022; 33:1243-1256. [PMID: 35165774 PMCID: PMC9106644 DOI: 10.1007/s00198-021-06174-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 09/23/2021] [Indexed: 12/05/2022]
Abstract
UNLABELLED To evaluate whether treatment sequence affects romosozumab response, this analysis reviewed studies where romosozumab was administered before or following an antiresorptive (alendronate or denosumab). Initial treatment with romosozumab followed by an antiresorptive resulted in larger increases in bone mineral density of both hip and spine compared with the reverse sequence. INTRODUCTION Teriparatide followed by an antiresorptive increases bone mineral density (BMD) more than using an antiresorptive first. To evaluate whether treatment sequence affects romosozumab response, we reviewed randomized clinical trials where romosozumab was administered before (ARCH, FRAME) or following (STRUCTURE, Phase 2 extension) an antiresorptive (alendronate or denosumab, respectively). METHODS We evaluated BMD percentage change for total hip (TH) and lumbar spine (LS) and response rates (BMD gains ≥ 3% and ≥ 6%) at years 1 and 2 (except STRUCTURE with only 1-year data available). RESULTS With 1-year romosozumab initial therapy in ARCH and FRAME, TH BMD increased 6.2% and 6.0%, and LS BMD increased 13.7% and 13.1%, respectively. When romosozumab was administered for 1 year after alendronate (STRUCTURE) or denosumab (Phase 2 extension), TH BMD increased 2.9% and 0.9%, respectively, and LS BMD increased 9.8% and 5.3%, respectively. Over 2 years, TH and LS BMD increased 7.1% and 15.2% with romosozumab/alendronate, 8.5% and 16.6% with romosozumab/denosumab, and 3.8% and 11.5% with denosumab/romosozumab, respectively. A greater proportion of patients achieved BMD gains ≥ 6% when romosozumab was used first, particularly for TH, versus the reverse sequence (69% after romosozumab/denosumab; 15% after denosumab/romosozumab). CONCLUSION In this study, larger mean BMD increases and greater BMD responder rates were achieved when romosozumab was used before, versus after, an antiresorptive agent. Since BMD on treatment is a strong surrogate for bone strength and fracture risk, this analysis supports the thesis that initial treatment with romosozumab followed by an antiresorptive will result in greater efficacy versus the reverse sequence.
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Affiliation(s)
- Felicia Cosman
- College of Physicians and Surgeons, Columbia University, 630 W 168th St, New York, NY, 10032, USA.
| | | | | | - Benjamin Z Leder
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - E Michael Lewiecki
- New Mexico Clinical Research & Osteoporosis Center, Albuquerque, NM, USA
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Rooney AM, Dempster DW, Nieves JW, Zhou H, Bostrom MPG, Cosman F. Effects of teriparatide and loading modality on modeling-based and remodeling-based bone formation in the human femoral neck. Bone 2022; 157:116342. [PMID: 35092891 PMCID: PMC8941636 DOI: 10.1016/j.bone.2022.116342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/05/2022] [Accepted: 01/24/2022] [Indexed: 01/23/2023]
Abstract
PURPOSE We have previously shown that a brief course of teriparatide (TPTD) stimulates bone formation in the cancellous and endocortical envelopes of the human femoral neck, and the regions of tension and compression respond differently. The purpose of the present study was to determine how much of the new bone was formed by modeling-based formation (MBF) or remodeling-based formation (RBF). METHODS We performed a double-blind trial of TPTD vs. placebo (PBO) in patients about to undergo a total hip replacement (THR) for osteoarthritis. Participants were randomized to receive daily TPTD 20 μg or PBO for an average of 6.1 weeks (range 4.1-11.8 weeks) prior to THR. After an average of 3 weeks of study drug, double tetracycline labels were administered per standard protocol. During the THR an intact sample of the mid-femoral neck (FN) was procured; this was fixed, embedded, and sectioned transversely. Histomorphometric analysis was performed in the cancellous, endocortical, and periosteal envelopes. Additionally, separate analyses were performed in the tensile and compressive regions of the endocortical and periosteal envelopes. Sites of new bone formation were identified by the presence of tetracycline labels and designated as MBF if the underlying cement line was smooth and as RBF if it was scalloped. New bone formation on smooth cement lines adjacent to scalloped reversal lines was designated as overflow RBF (oRBF). The referent for all indices was bone surface (BS). RESULTS In the cancellous and endocortical envelopes, the proportion of mineralizing surface engaged in RBF and oRBF was higher in the TPTD-treated than the PBO-treated subjects. There was also a trend toward higher MBF in TPTD vs. PBO in both envelopes. In linear mixed-effects models, TPTD was predicted to increase formation differently on the tensile and compressive surfaces depending on patient-specific anatomy, including body weight, FN angle, offset, and cortical width and porosity. Eroded surface was not different between groups in either envelope and no significant differences were observed in any parameter in the periosteal envelope. CONCLUSION We conclude that the predominant early effect of TPTD in the human femoral neck is to stimulate RBF and oRBF with a trend toward an increase in MBF in the endocortical and cancellous envelopes.
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Affiliation(s)
- Amanda M Rooney
- Nancy E. and Peter C. Meinig School of Biomedical Engineering, Cornell University, 101 Weill Hall, Ithaca, NY 14853, USA.
| | - David W Dempster
- Regional Bone Center, Helen Hayes Hospital, 55 N Route 9W, West Haverstraw, NY 10993, USA; Department of Pathology, Columbia University, 630 West 168th St., New York, NY 10025, USA
| | - Jeri W Nieves
- Regional Bone Center, Helen Hayes Hospital, 55 N Route 9W, West Haverstraw, NY 10993, USA; Department of Epidemiology, Columbia University, 722 West 168th St., New York, NY 10032, USA; Research Division, Hospital for Special Surgery, 515 East 71st St., New York, NY 10021, USA.
| | - Hua Zhou
- Regional Bone Center, Helen Hayes Hospital, 55 N Route 9W, West Haverstraw, NY 10993, USA
| | - Mathias P G Bostrom
- Research Division, Hospital for Special Surgery, 515 East 71st St., New York, NY 10021, USA.
| | - Felicia Cosman
- Department of Medicine, Columbia University, 622 West 168th St., New York, NY 10032, USA.
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Nieves JW, Cosman F, McMahon D, Redko M, Hentschel I, Bartolotta R, Loftus M, Kazam JJ, Rotman J, Lane J. Teriparatide and pelvic fracture healing: a phase 2 randomized controlled trial. Osteoporos Int 2022; 33:239-250. [PMID: 34383100 PMCID: PMC8758515 DOI: 10.1007/s00198-021-06065-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 07/08/2021] [Indexed: 01/03/2023]
Abstract
UNLABELLED Pelvic fracture patients were randomized to blinded daily subcutaneous teriparatide (TPTD) or placebo to assess healing and functional outcomes over 3 months. With TPTD, there was no evidence of improved healing by CT or pain reduction; however, physical performance improved with TPTD but not placebo (group difference p < 0.03). INTRODUCTION To determine if teriparatide (20 μg/day; TPTD) results in improved radiologic healing, reduced pain, and improved functional outcome vs placebo over 3 months in pelvic fracture patients. METHODS This randomized, placebo-controlled study enrolled 35 patients (women and men >50 years old) within 4 weeks of pelvic fracture and evaluated the effect of blinded TPTD vs placebo over 3 months on fracture healing. Fracture healing from CT images at 0 and 3 months was assessed as cortical bridging using a 5-point scale. The numeric rating scale (NRS) for pain was administered monthly. Physical performance was assessed monthly by Continuous Summary Physical Performance Score (based on 4 m walk speed, timed repeated chair stands, and balance) and the Timed Up and Go (TUG) test. RESULTS The mean age was 82, and >80% were female. The intention to treat analysis showed no group difference in cortical bridging score, and 50% of fractures in TPTD-treated and 53% of fractures in placebo-treated patients were healed at 3 months, unchanged after adjustment for age, sacral fracture, and fracture displacement. Median pain score dropped significantly in both groups with no group differences. Both CSPPS and TUG improved in the teriparatide group, whereas there was no improvement in the placebo group (group difference p < 0.03 for CSPPS at 2 and 3 months). CONCLUSION In this small randomized, blinded study, there was no improvement in radiographic healing (CT at 3 months) or pain with TPTD vs placebo; however, there was improved physical performance in TPTD-treated subjects that was not evident in the placebo group.
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Affiliation(s)
- J W Nieves
- Hospital for Special Surgery, New York, NY, USA.
- Department of Epidemiology, Columbia University, New York, NY, USA.
| | - F Cosman
- Department of Medicine, Columbia University, New York, NY, USA
| | - D McMahon
- Hospital for Special Surgery, New York, NY, USA
| | - M Redko
- Hospital for Special Surgery, New York, NY, USA
| | - I Hentschel
- Hospital for Special Surgery, New York, NY, USA
| | - R Bartolotta
- Department of Radiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - M Loftus
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - J J Kazam
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - J Rotman
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - J Lane
- Hospital for Special Surgery, New York, NY, USA
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Kendler DL, Cosman F, Stad RK, Ferrari S. Denosumab in the Treatment of Osteoporosis: 10 Years Later: A Narrative Review. Adv Ther 2022; 39:58-74. [PMID: 34762286 PMCID: PMC8799550 DOI: 10.1007/s12325-021-01936-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 09/27/2021] [Indexed: 12/12/2022]
Abstract
The fully human monoclonal antibody denosumab was approved for treatment of osteoporosis in 2010 on the basis of its potent antiresorptive activity, which produces clinically meaningful increases in bone mineral density (BMD) and reduces fracture risk at key skeletal sites. At that time, questions remained regarding the long-term safety and efficacy of this receptor activator of nuclear factor kappa-B ligand (RANKL) inhibitor; and with clinical experience, new questions have arisen regarding its optimal use. Here, we examine these questions through the lens of data from the FREEDOM trial program and other studies to determine where denosumab fits in the osteoporosis treatment landscape. Clinical consensus and evidentiary support have grown for denosumab as a highly effective anti-osteoporosis therapy for patients at high risk of fracture. In the 10-year FREEDOM Extension study, denosumab treatment produced progressive incremental increases in BMD, sustained low rates of vertebral fracture, and further reduction in nonvertebral fracture risk without increased risk of infection, cancer, or immunogenicity. There was no evidence that suppression of bone turnover or mineralization was excessive, and rates of osteonecrosis of the jaw (ONJ) and atypical femoral fracture (AFF) were very low. It is now recognized, however, that transitioning to another anti-osteoporosis therapy after denosumab discontinuation is essential to mitigate a transient rebound of bone turnover causing rapid BMD loss and increased risk of multiple vertebral fractures (MVFs). Taken together, the available data show that denosumab has a favorable benefit/risk profile and is a versatile agent for preventing osteoporotic fractures in the short and long term. Video abstract: Denosumab in the Treatment of Osteoporosis—10 Years Later (MP4 62727 KB)
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Cosman F, Libanati C, Deignan C, Yu Z, Wang Z, Ferrari S, Beck Jensen JE, Peris P, Bertoldo F, Lespessailles E, Hesse E, Cummings SR. Romosozumab Followed by Antiresorptive Treatment Increases the Probability of Achieving Bone Mineral Density Treatment Goals. JBMR Plus 2021; 5:e10546. [PMID: 34761149 PMCID: PMC8567484 DOI: 10.1002/jbm4.10546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/28/2021] [Indexed: 11/09/2022] Open
Abstract
Increases in bone mineral density (BMD) with osteoporosis treatment are associated with reduced fracture risk. Increasing BMD is therefore a goal of osteoporosis therapy. Here, we compare the probability of achieving a T-score of > -2.5 over 3 years at the total hip (TH) or lumbar spine (LS) in women with osteoporosis, ≥55 years of age, after the following treatment sequences: 1 year romosozumab followed by 2 years denosumab (FRAME and FRAME extension trials), 1 year romosozumab followed by 2 years alendronate, or alendronate-only for 3 years (ARCH trial). Probabilities of attaining the BMD target within 1 year of treatment were also determined. At both skeletal sites, in women with a baseline Tscore ≥ -2.7, there was >50% probability of achieving the BMD target with any 3-year regimen. The probability of achieving the target BMD in those with a baseline TH Tscore equal to -3.0 was 61% with romosozumab/denosumab, 38% with romosozumab/alendronate, and 9% with alendronate. In those with a baseline LS Tscore equal to -3.0, the probability of achieving a T-score > -2.5 was 93% with romosozumab/denosumab, 81% with romosozumab/alendronate, and 55% with alendronate. With 1 year of treatment, in patients with a baseline TH T-score equal to -2.7, the probability of reaching the target Tscore with romosozumab was 71% to 78% and 38% with alendronate. For patients with an initial LS T-score equal to -3.0, the probability of achieving the target T-score over 1 year was 85% to 86% with romosozumab and 25% for alendronate. Our findings suggest baseline BMD and the probability of achieving BMD T-score goals are factors to consider when selecting initial treatment for patients with osteoporosis. As baseline T-score falls below -2.7 (TH) and -3.0 (LS), alendronate has <50% likelihood of achieving a BMD goal above osteoporosis range, whereas these probabilities remain relatively high for regimens beginning with romosozumab. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
| | | | | | | | | | | | | | - Pilar Peris
- Hospital Clinic, IDIBAPS University of Barcelona Barcelona Spain
| | | | - Eric Lespessailles
- Centre Hospitalier Régional d'Orléans University of Orléans Orleans France
| | - Eric Hesse
- Institute of Molecular Musculoskeletal Research University Hospital, LudwigMaximilians-University Munich Germany
| | - Steven R Cummings
- University of California San Francisco San Francisco Coordinating Center San Francisco CA USA
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15
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Saag K, Cosman F, De Villiers T, Langdahl B, Scott BB, Denker AE, Pong A, Santora AC. Early changes in bone turnover and bone mineral density after discontinuation of long-term oral bisphosphonates: a post hoc analysis. Osteoporos Int 2021; 32:1879-1888. [PMID: 33606045 DOI: 10.1007/s00198-020-05785-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 12/07/2020] [Indexed: 10/22/2022]
Abstract
UNLABELLED This post hoc analysis of a randomized, double-blind study of postmenopausal women with osteoporosis found that there were early increases in bone turnover markers and decreases in bone mineral density after discontinuation of long-term alendronate. These findings might help guide treatment decisions, including monitoring after alendronate withdrawal. INTRODUCTION The short-term effects of discontinuing long-term bisphosphonates are poorly characterized. This post hoc analysis investigated 1-12-month changes in bone mineral density (BMD) and bone turnover markers (BTM) after alendronate (ALN) discontinuation. METHODS Data were from a randomized, double-blind trial of MK-5442 (calcium-sensing receptor antagonist) following oral bisphosphonates, with placebo and continued ALN controls ( ClinicalTrials.gov NCT00996801). Postmenopausal women with osteoporosis had received oral bisphosphonate (≥ 3-4 preceding years; ALN for the 12 months pre-screening), continuing on ALN 70 mg/week (n = 87) or placebo (n = 88). RESULTS At 12 months, least-squares mean percent changes from baseline BMD (placebo vs. ALN) were lumbar spine (LS): - 0.36 vs. 1.29, total hip: - 1.44 vs. 0.46, and femoral neck (FN): - 1.26 vs. - 0.08 (all P < 0.05). BTM levels increased by 1-3 months, to 12 months, with placebo vs. ALN (P < 0.001). FN BMD decline was greater in the placebo subgroup with higher urinary N-terminal cross-linked telopeptides of type I collagen/creatinine [uNTx/Cr] (P < 0.01), and higher serum N-terminal pro-peptide of type 1 collagen [P1NP] levels (P < 0.05), at baseline. There was a trend toward greater FN BMD loss with higher BTM levels at 3 and/or 6 months. Younger age and higher LS BMD at baseline were associated with greater LS BMD loss at 12 months (P = 0.04 and < 0.01, respectively); higher baseline FN BMD predicted greater FN BMD loss (P = 0.04). CONCLUSION Early changes in BTM levels and BMD were observed after discontinuation of long-term ALN. Further characterization of factors associated with patients' risk of bone loss upon bisphosphonate discontinuation is warranted.
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Affiliation(s)
- K Saag
- University of Alabama, Birmingham, AL, USA.
| | - F Cosman
- Department of Medicine, Columbia University, New York, NY, USA
| | - T De Villiers
- Stellenbosch University and Mediclinic Panorama, Western Cape, South Africa
| | - B Langdahl
- Aarhus University Hospital, Aarhus, Denmark
| | - B B Scott
- Merck & Co., Inc, Kenilworth, NJ, USA
| | | | - A Pong
- Merck & Co., Inc, Kenilworth, NJ, USA
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Papapoulos S, Bone H, Cosman F, Dempster DW, McClung MR, Nakamura T, Restrepo JFM, Bouxsein ML, Cohn D, de Papp A, Massaad R, Santora A. Incidence of Hip and Subtrochanteric/Femoral Shaft Fractures in Postmenopausal Women With Osteoporosis in the Phase 3 Long-Term Odanacatib Fracture Trial. J Bone Miner Res 2021; 36:1225-1234. [PMID: 33724542 DOI: 10.1002/jbmr.4284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 03/01/2021] [Accepted: 03/08/2021] [Indexed: 12/23/2022]
Abstract
We prospectively assessed, with predefined criteria, the location and rates of all femur fractures (hip, subtrochanteric/femoral shaft [ST/FS], including atypical [AFF] and distal fractures) in women at increased fracture risk during treatment with the cathepsin K inhibitor, odanacatib (ODN), or placebo over 5 years in the Long-Term ODN Fracture Trial (LOFT and LOFT Extension [NCT00529373, EudraCT 2007-002693-66]). ODN was an investigational antiresorptive agent previously in development as an osteoporosis treatment that, unlike bisphosphonates, reduces bone formation only transiently. Women aged ≥65 years with a bone mineral density (BMD) T-score ≤-2.5 at the total hip (TH) or femoral neck (FN) or with a radiographic vertebral fracture and T-scores ≤-1.5 at the TH or FN were randomized (1:1) to receive ODN 50 mg/week or placebo. All patients received vitamin D3 (5600 IU/week) and calcium (total 1200 mg/d); the analysis included 16,071 women. Rates of all adjudicated low-energy femoral fractures were 0.38 versus 0.58/100 patient-years for ODN and placebo, respectively (hazard ratio [HR] = 0.65; 95% confidence interval [CI] 0.51-0.82; nominal p < .001), and for low-energy hip fractures were 0.29 versus 0.56/100 patient-years, respectively (HR = 0.52; 95% CI 0.40-0.67; p < .001). The cumulative incidence of combined hip and ST/FS or hip fractures alone in the ODN group was consistently lower than in the placebo group (1.93% versus 3.11% for combined fractures and 1.53% versus 3.03% for hip fractures at 5 years, respectively). However, low-energy ST/FS fractures were more frequent in ODN-treated women than in placebo-treated women (24 versus 6, respectively). Among these, 12 fractures were adjudicated as AFF in 10 patients treated with ODN (0.03/100 patient-years) compared with none in the 6 placebo-treated women (estimated difference 0.03; 95% CI 0.02-0.06). These results provide insight into possible pathogeneses of AFF, suggesting that the current criteria for diagnosing these fractures may need to be reconsidered. © 2021 American Society for Bone and Mineral Research (ASBMR)..
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Affiliation(s)
| | - Henry Bone
- Michigan Bone & Mineral Clinic, Detroit, MI, USA
| | | | | | - Michael R McClung
- Oregon Osteoporosis Center, Portland, OR, USA.,Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | | | | | - Mary L Bouxsein
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, and Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, USA
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Abstract
PURPOSE OF REVIEW There are now three anabolic agents available for the treatment of postmenopausal women at high risk for fracture. The purpose of this review is to supply a rationale to aid in determining which agent should be used in which clinical settings. RECENT FINDINGS Studies over the last decade have shown that anabolic agents produce faster and larger effects against fracture than antiresorptive agents. Furthermore, trials evaluating anabolic antiresorptive treatment sequences have shown that anabolic first treatment strategies produce the greatest benefits to bone density, particularly in the hip region. However, there are no head-to-head evaluations of the three anabolic therapies with fracture outcomes or bone density, and these studies are not likely to occur. How to decide which agent to use at which time in a woman's life is unknown. We review the most significant clinical trials of anabolic agents which have assessed fracture, areal or volumetric bone density, microarchitecture, and/or bone strength, as well as information gleaned from histomorphometry studies to provide a rationale for consideration of one agent vs another in various clinical settings. There is no definitive answer to this question; all three agents increase bone strength and reduce fracture risk rapidly. Since the postmenopausal lifespan could be as long as 40-50 years, it is likely that very high-risk women will utilize different anabolic agents at different points in their lives.
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Affiliation(s)
- Felicia Cosman
- Department of Medicine, College of Physicians and Surgeons of Columbia University, 630 West 168th Street, New York, NY, 10032-3784, USA.
- Endocrinology, College of Physicians and Surgeons of Columbia University, New York, NY, USA.
| | - David W Dempster
- Department of Pathology and Cell Biology, College of Physicians and Surgeons of Columbia University, 630 West 168th Street, New York, NY, 10032-3784, USA
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Yang J, Cosman F, Stone PW, Li M, Nieves JW. Vertebral fracture assessment (VFA) for osteoporosis screening in US postmenopausal women: is it cost-effective? Osteoporos Int 2020; 31:2321-2335. [PMID: 32778935 DOI: 10.1007/s00198-020-05588-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 08/04/2020] [Indexed: 01/03/2023]
Abstract
UNLABELLED Vertebral fracture assessment (VFA) is cost-effective when it was incorporated in the routine screening for osteoporosis in community-dwelling women aged ≥ 65 years, which support guidelines, such as the National Osteoporosis Foundation (NOF) for the diagnostic use of VFA as an important addition to fracture risk assessment. INTRODUCTION To evaluate the cost-effectiveness of VFA as a screening tool to reduce future fracture risk in US community-dwelling women aged ≥ 65 years. METHODS An individual-level state-transition cost-effectiveness model from a healthcare perspective was constructed using derived data from published literature. The time horizon was lifetime. Five screening strategies were compared, including no screening at all, central dual-energy X-ray absorptiometry (DXA) only, VFA only, central DXA followed by VFA if the femoral neck T-score (FN-T) ≤ - 1.5, or if the FN-T ≤ - 1.0. Various initiation ages and rescreening intervals were evaluated. Oral bisphosphonate treatment for 5-year periods was assumed. Incremental cost-effectiveness ratios (2017 US dollars per quality-adjusted life-year (QALY) gained) were used as the outcome measure. RESULTS The incorporation of VFA slightly increased life expectancy by 0.1 years and reduced the number of subsequent osteoporotic fractures by 3.7% and 7.7% compared with using DXA alone and no screening, respectively, leading to approximately 30 billion dollars saved. Regardless of initiation ages and rescreening intervals, central DXA followed by VFA if the FN-T ≤ - 1.0 was most cost-effective ($40,792 per QALY when the screening is initiated at age 65 years and with rescreening every 5 years). Results were robust to change in VF incidence and medication costs. CONCLUSION In women aged ≥ 65 years, VFA is cost-effective when it was incorporated in routine screening for osteoporosis. Our findings support the National Osteoporosis Foundation (NOF) guidelines for the diagnostic use of VFA as an important addition to fracture risk assessment.
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Affiliation(s)
- J Yang
- Institute for Social and Economic Research and Policy (ISERP), Columbia University, New York, NY, 10027, USA
| | - F Cosman
- Department of Medicine, Columbia University, New York, NY, 10032, USA
| | - P W Stone
- School of Nursing, Columbia University, New York, NY, USA
| | - M Li
- Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, CA, USA
| | - J W Nieves
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, 10032, USA.
- Hospital for Special Surgery, New York, NY, 10021, USA.
- Department of Epidemiology and Institute of Human Nutrition, Columbia University, 630 West 168th Street, IHN PH 1512, New York, NY, 10032, USA.
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Cosman F, Peterson LR, Towler DA, Mitlak B, Wang Y, Cummings SR. Cardiovascular Safety of Abaloparatide in Postmenopausal Women With Osteoporosis: Analysis From the ACTIVE Phase 3 Trial. J Clin Endocrinol Metab 2020; 105:5870711. [PMID: 32658264 PMCID: PMC7500469 DOI: 10.1210/clinem/dgaa450] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 07/08/2020] [Indexed: 12/20/2022]
Abstract
CONTEXT Abaloparatide is a US Food and Drug Administration-approved parathyroid hormone-related peptide analog for treatment of osteoporosis in postmenopausal women at high risk of fracture. OBJECTIVES We assessed the cardiovascular safety profile of abaloparatide. DESIGN Review of heart rate (HR), blood pressure (BP), and cardiovascular-related adverse events (AEs), including major adverse cardiovascular events (MACEs) and heart failure (HF) from: (a) ACTIVE (NCT01343004), a phase 3 trial that randomized 2463 postmenopausal women with osteoporosis to abaloparatide, teriparatide, or placebo for 18 months; (b) ACTIVExtend (NCT01657162), where participants from the abaloparatide and placebo arms received alendronate for 2 years; and (c) a pharmacology study in 55 healthy adults. RESULTS Abaloparatide and teriparatide transiently increased HR relative to placebo. Following first dose, mean (standard deviation [SD]) HR change from pretreatment to 1 hour posttreatment was 7.9 (8.5) beats per minute (bpm) for abaloparatide, 5.3 (7.5) for teriparatide, and 1.2 (7.1) for placebo. A similar pattern was observed over subsequent visits. In healthy volunteers, HR increase resolved within 4 hours. The corresponding change in mean supine systolic and diastolic BP 1 hour posttreatment was -2.7/-3.6 mmHg (abaloparatide), -2.0/-3.6 (teriparatide), and -1.5/-2.3 (placebo). The percentage of participants with serious cardiac AEs was similar among groups (0.9%-1.0%). In a post hoc analysis, time to first incidence of MACE + HF was longer with abaloparatide (P = 0.02 vs placebo) and teriparatide (P = 0.04 vs placebo). CONCLUSIONS Abaloparatide was associated with transient increases in HR and small decreases in BP in postmenopausal women with osteoporosis, with no increase in risk of serious cardiac AEs, MACE, or HF.
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Affiliation(s)
- Felicia Cosman
- Department of Medicine, Columbia University, New York, New York
| | - Linda R Peterson
- Diabetic Cardiovascular Disease Center and Department of Medicine, Washington University, St Louis, Missouri
| | - Dwight A Towler
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas
| | - Bruce Mitlak
- Clinical Development, Radius Health, Inc., Waltham, Massachusetts
- Correspondence: Bruce Mitlak, MD, Vice President Clinical Development, Radius Health, Inc., 950 Winter Street, Waltham, MA 02451, USA. E-mail:
| | - Yamei Wang
- Biostatistics, Radius Health, Inc., Waltham, Massachusetts
| | - Steven R Cummings
- San Francisco Coordinating Center, Sutter Health, California; University of California, San Francisco, California
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Miller PD, Bilezikian JP, Fitzpatrick LA, Mitlak B, McCloskey EV, Cosman F, Bone HG. Abaloparatide: an anabolic treatment to reduce fracture risk in postmenopausal women with osteoporosis. Curr Med Res Opin 2020; 36:1861-1872. [PMID: 32969719 DOI: 10.1080/03007995.2020.1824897] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Fractures due to osteoporosis represent a serious burden on patients and healthcare systems. The objective of this review is to provide an overview of the anabolic agent abaloparatide (ABL) for the treatment of postmenopausal women with osteoporosis at high risk for fracture. METHODS A literature review was conducted using PubMed to identify articles focused on ABL published prior to February 10, 2020, using the search term "abaloparatide". RESULTS ABL, a synthetic analog of human parathyroid hormone-related protein, increased bone mineral density (BMD), improved bone microarchitecture, and increased bone strength in preclinical and clinical studies. The pivotal phase 3 trial ACTIVE and its extension (ACTIVExtend) demonstrated the efficacy of initial treatment with ABL for 18 months followed by sequential treatment with alendronate (ALN) for an additional 24 months to reduce the risk of vertebral, nonvertebral, clinical, and major osteoporotic fractures and to increase BMD in postmenopausal women with osteoporosis. Discontinuations from ACTIVE were slightly more common in ABL-treated patients due to dizziness, palpitations, nausea, and headache. Post hoc analyses of ACTIVE and ACTIVExtend support the efficacy and safety of ABL in relevant subpopulations including postmenopausal women with various baseline risk factors, women ≥80 years, women with type 2 diabetes mellitus, and women with renal impairment. CONCLUSIONS ABL is an effective and well-tolerated treatment for women with postmenopausal osteoporosis at high risk for fracture. Its therapeutic effects are sustained with subsequent ALN therapy.
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Affiliation(s)
- Paul D Miller
- Colorado Center for Bone Research, Denver, CO, USA
- Colorado Center for Bone Health, Golden, CO, USA
| | - John P Bilezikian
- Division of Endocrinology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | | | | | - Eugene V McCloskey
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Felicia Cosman
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Henry G Bone
- Michigan Bone and Mineral Clinic, P.C., Detroit, MI, USA
- Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, MI, USA
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21
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Watts NB, Hattersley G, Fitzpatrick LA, Wang Y, Williams GC, Miller PD, Cosman F. Correction to: Abaloparatide effect on forearm bone mineral density and wrist fracture risk in postmenopausal women with osteoporosis. Osteoporos Int 2020; 31:1603-1605. [PMID: 32533195 PMCID: PMC7360655 DOI: 10.1007/s00198-020-05469-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The original version of this article, published on 21 March 2019, unfortunately contains some typos in Figs. 2, 3, 4, and Supplemental Fig. 1. The corrected figures are given below.
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Affiliation(s)
- N B Watts
- Mercy Health Osteoporosis and Bone Health Services, Cincinnati, OH, USA.
| | | | | | - Y Wang
- Radius Health, Inc., Waltham, MA, USA
| | | | - P D Miller
- Colorado Center for Bone Research, Lakewood, CO, USA
| | - F Cosman
- Columbia University College of Physicians and Surgeons, New York, NY, USA
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22
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Dempster DW, Chines A, Bostrom MP, Nieves JW, Zhou H, Chen L, Pannacciulli N, Wagman RB, Cosman F. Modeling-Based Bone Formation in the Human Femoral Neck in Subjects Treated With Denosumab. J Bone Miner Res 2020; 35:1282-1288. [PMID: 32163613 PMCID: PMC9328280 DOI: 10.1002/jbmr.4006] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 02/25/2020] [Accepted: 03/04/2020] [Indexed: 12/13/2022]
Abstract
Denosumab is associated with continued gains in hip and spine BMD with up to 10 years of treatment in postmenopausal women with osteoporosis. Despite potent inhibition of bone remodeling, findings in nonhuman primates suggest modeling-based bone formation (MBBF) may persist during denosumab treatment. This study assessed whether MBBF in the femoral neck (FN) is preserved in the context of inhibited remodeling in subjects receiving denosumab. This open-label study enrolled postmenopausal women with osteoporosis who had received two or more doses of denosumab (60 mg subcutaneously every 6 months [Q6M]) per standard of care and were planning elective total hip replacement (THR) owing to osteoarthritis of the hip. Transverse sections of the FN were obtained after THR and analyzed histomorphometrically. MBBF, based on fluorochrome labeling and presence of smooth cement lines, was evaluated in cancellous, endocortical, and periosteal envelopes of the FN. Histomorphometric parameters were used to assess MBBF and remodeling-based bone formation (RBBF) in denosumab-treated subjects (n = 4; mean age = 73.5 years; range, 70 to 78 years) and historical female controls (n = 11; mean age = 67.8 years; range, 62 to 80 years) obtained from the placebo group of a prior study and not treated with denosumab. All analyses were descriptive. All subjects in both groups exhibited MBBF in the periosteal envelope; in cancellous and endocortical envelopes, all denosumab-treated subjects and 81.8% of controls showed evidence of MBBF. Compared with controls, denosumab-treated subjects showed 9.4-fold and 2.0-fold higher mean values of MBBF in cancellous and endocortical envelopes, respectively, whereas RBBF mean values were 5.0-fold and 5.3-fold lower. In the periosteal envelope, MBBF and RBBF rates were similar between subjects and controls. These results demonstrate the occurrence of MBBF in the human FN and suggest that denosumab preserves MBBF while inhibiting remodeling, which may contribute to the observed continued gains in BMD over time after remodeling is maximally inhibited. © 2020 The Authors. Journal of Bone and Mineral Research published by American Society for Bone and Mineral Research.
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Affiliation(s)
- David W Dempster
- Columbia University, New York, NY, USA.,Helen Hayes Hospital, West Haverstraw, NY, USA
| | | | | | - Jeri W Nieves
- Columbia University, New York, NY, USA.,Helen Hayes Hospital, West Haverstraw, NY, USA
| | - Hua Zhou
- Helen Hayes Hospital, West Haverstraw, NY, USA
| | - Li Chen
- Amgen Inc, Thousand Oaks, CA, USA
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23
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Cosman F, Lewiecki EM, Ebeling PR, Hesse E, Napoli N, Matsumoto T, Crittenden DB, Rojeski M, Yang W, Libanati C, Ferrari S. T-Score as an Indicator of Fracture Risk During Treatment With Romosozumab or Alendronate in the ARCH Trial. J Bone Miner Res 2020; 35:1333-1342. [PMID: 32445228 PMCID: PMC9328657 DOI: 10.1002/jbmr.3996] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 02/06/2020] [Accepted: 02/27/2020] [Indexed: 11/05/2022]
Abstract
In the Active-Controlled Fracture Study in Postmenopausal Women With Osteoporosis at High Risk (ARCH) clinical trial (NCT01631214), 1 year of romosozumab followed by alendronate reduced the risk of vertebral and nonvertebral fractures compared to alendronate alone in women with prevalent fracture. We performed post hoc analyses of data from patients in ARCH (romosozumab, n = 1739; alendronate, n = 1726) who had a baseline BMD measurement and received at least one open-label alendronate dose. We evaluated 1-year mean BMD and corresponding T-score changes; proportions of patients achieving T-scores > -2.5 at the total hip (TH), femoral neck (FN), and lumbar spine (LS); and group differences in fracture rates after 12 months, while all participants were on alendronate. Subsequently, we investigated the relationship between T-scores achieved at the TH, FN, and LS at 12 months and subsequent fracture incidence. At 1 year, mean change from baseline in TH BMD was 6.3% (T-score change 0.31) with romosozumab versus 2.9% (T-score change 0.15) with alendronate (p < .001). The proportion of patients with TH T-score > -2.5 increased from 34% at baseline to 55% after 1 year of romosozumab and from 32% at baseline to 44% after 1 year of alendronate. Compared with patients receiving alendronate in year 1, those receiving romosozumab had a 75% reduction in new or worsening vertebral fracture (p < .001) in year 2, and a 19% reduction in nonvertebral fracture (p = .120) and 40% reduction in hip fracture (p = .041) during the open-label period. TH and FN T-scores achieved at month 12 were associated with subsequent nonvertebral and vertebral fracture rates and the relationships were independent of treatment received. LS T-score at 12 months was associated with vertebral but not nonvertebral fracture risk. We conclude that 1 year of romosozumab leads to larger BMD gains versus alendronate, and that the T-score achieved with either therapy is related to subsequent fracture risk. These data support the use of T-score as a therapeutic target for patients with osteoporosis. © 2020 The Authors. Journal of Bone and Mineral Research published by American Society for Bone and Mineral Research.
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Affiliation(s)
- Felicia Cosman
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - E Michael Lewiecki
- New Mexico Clinical Research & Osteoporosis Center, Albuquerque, NM, USA
| | - Peter R Ebeling
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - Eric Hesse
- Institute of Molecular Musculoskeletal Research, Faculty of Medicine, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
| | | | - Toshio Matsumoto
- Fujii Memorial Institute of Medical Sciences, University of Tokushima, Tokushima, Japan
| | | | | | | | | | - Serge Ferrari
- Service and Laboratory of Bone Diseases, Geneva University Hospital, Geneva, Switzerland
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24
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Cosman F. Anabolic Therapy and Optimal Treatment Sequences for Patients With Osteoporosis at High Risk for Fracture. Endocr Pract 2020; 26:777-786. [PMID: 33471647 DOI: 10.4158/ep-2019-0596] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 03/01/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Provide an update regarding anabolic medications for osteoporosis, which are often considered to be the last resort for patients with osteoporosis, after multiple fractures have already occurred and other medications have already been administered. METHODS Literature review and discussion. RESULTS Recent pivotal trial data for anabolic agents and randomized trials comparing anabolic and antiresorptive medications suggest that three anabolic agents (teriparatide, abaloparatide, and romosozumab) reduce nonvertebral and vertebral fractures faster and to a greater extent than potent antiresorptive treatments. Furthermore, bone density accrual is maximized when patients are given anabolic agents first, followed by potent antiresorptive therapy. Since total hip bone density during or after osteoporosis treatment has emerged as an excellent surrogate for future fracture risk, attaining a greater hip bone mineral density is a treatment goal for high-risk osteoporosis patients. CONCLUSION This review defines the highest-risk patients and summarizes the rationale for the evolving role of anabolic therapy in the management of postmenopausal women at high risk for fracture. ABBREVIATIONS ACTIVE = Abaloparatide Comparator Trial in Vertebral Endpoints; ARCH = Active Controlled Fracture Study in Postmenopausal Women with Osteoporosis at High Risk; BMD = bone mineral density; FRAME = Fracture Study in Postmenopausal Women with Osteoporosis; FRAX = Fracture Risk Assessment Tool; PTH = parathyroid hormone; TBS = trabecular bone score.
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Affiliation(s)
- Felicia Cosman
- From the Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York..
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25
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Rooney AM, Bostrom MPG, Dempster DW, Nieves JW, Zhou H, Cosman F. Loading modality and age influence teriparatide-induced bone formation in the human femoral neck. Bone 2020; 136:115373. [PMID: 32330694 PMCID: PMC7263665 DOI: 10.1016/j.bone.2020.115373] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 04/01/2020] [Accepted: 04/18/2020] [Indexed: 12/14/2022]
Abstract
Teriparatide (TPTD) reduces risk of both vertebral and nonvertebral fracture, but increases bone mineral density (BMD) much more at the spine than the hip. TPTD and mechanical loading may have a synergistic anabolic effect on BMD, which may help explain these site-specific differences. Under normal daily activity, the femoral neck (FN) is under bending, placing one side under tension and the other under compression. We sought to further understand the relationship between mechanical loading and TPTD at the hip by investigating the effect of tensile versus compressive loading on TPTD stimulated bone formation indices in the human FN. Thirty-eight patients receiving total hip replacements for osteoarthritis were randomized to receive placebo (PBO) or TPTD for a mean treatment duration of 6 weeks prior to surgery, and double tetracycline labeling was administered to allow assessment of bone formation. The FN was harvested during surgery and analyzed for dynamic bone formation indices in the compressive and tensile regions of the endocortical and periosteal envelopes. Regression models relating outcome measures to patient characteristics including sex, age, body weight, and FN geometry were also analyzed. Overall, bone formation was higher with TPTD versus placebo on the endocortical surface, but not the periosteal surface. The level of bone formation in both TPTD and placebo groups was greater on the tensile endocortical surface and the compressive periosteal surface. There was a trend toward decreased endocortical eroded surface with TPTD in the compressive but not the tensile region. Patient age and sex explained the greatest variability in endocortical bone formation, and patient body mass and sex explained the greatest variability in periosteal bone formation. Our data represent the first dynamic comparison of teriparatide treatment under two loading modalities in human FN samples. Future work could determine whether specific hip loading intervention could amplify the benefits of teriparatide on the hip in clinical settings.
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Affiliation(s)
- Amanda M Rooney
- Nancy E. and Peter C. Meinig School of Biomedical Engineering, Cornell University, 101 Weill Hall, Ithaca, NY 14853, USA.
| | - Mathias P G Bostrom
- Research Division, Hospital for Special Surgery, 515 East 71st St., New York, NY 10021, USA.
| | - David W Dempster
- Regional Bone Center, Helen Hayes Hospital, 55 N Route 9W, West Haverstraw, NY 10993, USA; Department of Pathology, Columbia University, 630 West 168th St., New York, NY 10025, USA
| | - Jeri W Nieves
- Research Division, Hospital for Special Surgery, 515 East 71st St., New York, NY 10021, USA; Regional Bone Center, Helen Hayes Hospital, 55 N Route 9W, West Haverstraw, NY 10993, USA; Department of Epidemiology, Columbia University, 722 West 168th St., New York, NY 10032, USA.
| | - Hua Zhou
- Regional Bone Center, Helen Hayes Hospital, 55 N Route 9W, West Haverstraw, NY 10993, USA.
| | - Felicia Cosman
- Department of Medicine, Columbia University, 622 West 168th St., New York, NY 10032, USA.
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26
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Keaveny TM, Clarke BL, Cosman F, Orwoll ES, Siris ES, Khosla S, Bouxsein ML. Biomechanical Computed Tomography analysis (BCT) for clinical assessment of osteoporosis. Osteoporos Int 2020; 31:1025-1048. [PMID: 32335687 PMCID: PMC7237403 DOI: 10.1007/s00198-020-05384-2] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 03/09/2020] [Indexed: 12/12/2022]
Abstract
The surgeon general of the USA defines osteoporosis as "a skeletal disorder characterized by compromised bone strength, predisposing to an increased risk of fracture." Measuring bone strength, Biomechanical Computed Tomography analysis (BCT), namely, finite element analysis of a patient's clinical-resolution computed tomography (CT) scan, is now available in the USA as a Medicare screening benefit for osteoporosis diagnostic testing. Helping to address under-diagnosis of osteoporosis, BCT can be applied "opportunistically" to most existing CT scans that include the spine or hip regions and were previously obtained for an unrelated medical indication. For the BCT test, no modifications are required to standard clinical CT imaging protocols. The analysis provides measurements of bone strength as well as a dual-energy X-ray absorptiometry (DXA)-equivalent bone mineral density (BMD) T-score at the hip and a volumetric BMD of trabecular bone at the spine. Based on both the bone strength and BMD measurements, a physician can identify osteoporosis and assess fracture risk (high, increased, not increased), without needing confirmation by DXA. To help introduce BCT to clinicians and health care professionals, we describe in this review the currently available clinical implementation of the test (VirtuOst), its application for managing patients, and the underlying supporting evidence; we also discuss its main limitations and how its results can be interpreted clinically. Together, this body of evidence supports BCT as an accurate and convenient diagnostic test for osteoporosis in both sexes, particularly when used opportunistically for patients already with CT. Biomechanical Computed Tomography analysis (BCT) uses a patient's CT scan to measure both bone strength and bone mineral density at the hip or spine. Performing at least as well as DXA for both diagnosing osteoporosis and assessing fracture risk, BCT is particularly well-suited to "opportunistic" use for the patient without a recent DXA who is undergoing or has previously undergone CT testing (including hip or spine regions) for an unrelated medical condition.
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Affiliation(s)
- T M Keaveny
- Departments of Mechanical Engineering and Bioengineering, University of California, Berkeley, CA, USA.
| | - B L Clarke
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - F Cosman
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - E S Orwoll
- Bone and Mineral Unit, Oregon Health and Science University, Portland, OR, USA
| | - E S Siris
- Toni Stabile Osteoporosis Center, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - S Khosla
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - M L Bouxsein
- Orthopedic Biomechanics Laboratory, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
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27
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Watts NB, Hattersley G, Fitzpatrick LA, Wang Y, Williams GC, Miller PD, Cosman F. Correction to: Abaloparatide effect on forearm bone mineral density and wrist fracture risk in postmenopausal women with osteoporosis. Osteoporos Int 2020; 31:1017-1018. [PMID: 32232508 PMCID: PMC7170828 DOI: 10.1007/s00198-020-05349-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The original version of this article, published on 21 March 2019, unfortunately contained a mistake.
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Affiliation(s)
- N B Watts
- Mercy Health Osteoporosis and Bone Health Services, Cincinnati, OH, USA.
| | | | | | - Y Wang
- Radius Health, Inc., Waltham, MA, USA
| | | | - P D Miller
- Colorado Center for Bone Research, Lakewood, CO, USA
| | - F Cosman
- Columbia University College of Physicians and Surgeons, New York, NY, USA
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28
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Dash AS, Agarwal S, McMahon DJ, Cosman F, Nieves J, Bucovsky M, Guo XE, Shane E, Stein EM. Abnormal microarchitecture and stiffness in postmenopausal women with isolated osteoporosis at the 1/3 radius. Bone 2020; 132:115211. [PMID: 31870633 PMCID: PMC8853460 DOI: 10.1016/j.bone.2019.115211] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 12/18/2019] [Accepted: 12/18/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Postmenopausal women with isolated osteoporosis at the 1/3 radius (1/3RO) present a therapeutic dilemma. Little is known about whether these patients have generalized skeletal fragility, and whether this finding warrants treatment. The aim of this study was to investigate the biochemical and microarchitectural phenotype of women with 1/3RO compared to women with classic postmenopausal osteoporosis by DXA at the spine and hip (PMO), and controls without osteoporosis at any site. METHODS This cross-sectional study enrolled 266 postmenopausal women, who were grouped according to densitometric pattern. Subjects had serum biochemistries, areal BMD (aBMD) measured by DXA, trabecular and cortical vBMD, microarchitecture, and stiffness by high resolution peripheral QCT (HR-pQCT, voxel size ~82 μm) of the distal radius and tibia. RESULTS Mean age was 68 ± 7 years. DXA T-Scores reflected study design. By HR-pQCT, 1/3RO had abnormalities at both radius and tibia compared to controls: lower total, cortical and trabecular vBMD, cortical thickness and trabecular number, higher trabecular separation and heterogeneity, and lower whole bone stiffness. In contrast, the magnitude and pattern of abnormalities in vBMD, microarchitecture and stiffness in 1/3RO were similar to those in PMO; the difference compared to controls was similar among the two groups. Serum calcium, creatinine, parathyroid hormone, 25-hydroxyvitamin D, and 24-hour urine calcium did not differ. CONCLUSIONS Although aBMD appeared relatively preserved at the spine and hip by DXA, women with 1/3RO had significant microarchitectural and biomechanical deficits comparable to those in women with typical PMO. Further study is required to guide treatment decisions in this population.
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Affiliation(s)
- Alexander S Dash
- Endocrinology and Metabolic Bone Disease Service, Hospital for Special Surgery, New York, NY, United States of America
| | - Sanchita Agarwal
- Division of Endocrinology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, United States of America
| | - Donald J McMahon
- Endocrinology and Metabolic Bone Disease Service, Hospital for Special Surgery, New York, NY, United States of America; Division of Endocrinology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, United States of America
| | - Felicia Cosman
- Division of Endocrinology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, United States of America
| | - Jeri Nieves
- Endocrinology and Metabolic Bone Disease Service, Hospital for Special Surgery, New York, NY, United States of America; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Mariana Bucovsky
- Division of Endocrinology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, United States of America
| | - X Edward Guo
- Bone Bioengineering Laboratory, Department of Biomedical Engineering, Columbia University, New York, NY, United States of America
| | - Elizabeth Shane
- Division of Endocrinology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, United States of America
| | - Emily M Stein
- Endocrinology and Metabolic Bone Disease Service, Hospital for Special Surgery, New York, NY, United States of America.
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Misof BM, Roschger P, Zhou H, Nieves JW, Bostrom M, Cosman F, Lindsay R, Klaushofer K, Dempster DW. No evidence for alteration in early secondary mineralization by either alendronate, teriparatide or combination of both in transiliac bone biopsy samples from postmenopausal osteoporotic patients. Bone Rep 2020; 12:100253. [PMID: 32215284 PMCID: PMC7090359 DOI: 10.1016/j.bonr.2020.100253] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 02/26/2020] [Indexed: 12/20/2022] Open
Abstract
The influence of treatment with alendronate (ALN), teriparatide (TPTD) or concurrent treatment with both on the human bone matrix mineralization has not yet been fully elucidated. For this purpose we analyzed quadruple fluorochrome labelled transiliac bone biopsy samples (n = 66) from postmenopausal osteoporotic women with prior and ongoing ALN (ALN-Rx arm) or without ALN (Rx-Naïve arm) after 7 months treatment with cyclic or daily TPTD or without TPTD using quantitative backscattered electron imaging and confocal scanning laser microscopy. Additionally to the bone mineralization density distribution (BMDD) of entire cancellous and cortical compartments, we measured the mineralization kinetics, i.e. the calcium concentration between the younger (Ca_DL2) and older double labels (Ca_DL1), and in interstitial bone (Ca_int) in a subset of the biopsy cohort. We found the BMDD from the patients with prior and ongoing ALN generally shifted to higher calcium concentrations compared to those without ALN (average degree of mineralization in cancellous bone Cn.CaMean + 3.1%, p<0.001). The typical BMDD changes expected by cyclic or daily TPTD treatment due to the increased bone turnover/formation, e.g. an increase in low mineralized bone area were not observed. Additionally, we found no influence of treatment with ALN or TPTD or combination thereof on Ca_DL2, Ca_DL1, or Ca_int. Pooling the information from all groups, Ca_DL1 was +5.9% (p<0.001) higher compared to Ca_DL2, corresponding to a mineralization rate of 0.18 wt% Ca per week during the early secondary mineralization process. Our data suggest that the patients in the ALN-Rx arm had more highly mineralized bone matrix than those without ALN due to their lower bone turnover. The reason for the unexpected BMDD findings in the TPTD treated remain unknown and cannot be attributed to altered mineralization kinetics as no differences in the time course of early secondary mineralization were observed between the treatment groups. Quadruple fluorescence labeling provided analysis of early secondary bone mineralization rate in osteoporotic patients. Alendronate, teriparatide or combination of both had no influence on early secondary bone mineralization in patients. The early secondary mineralization rate (increase in mineral content with time) was found to be 0.18 wt% Ca per week. Patients in the ALN-Rx arm had higher average bone matrix mineralization than the patients in the Rx-naïve arm.
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Affiliation(s)
- Barbara M Misof
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1st Med. Dept. Hanusch Hospital, Vienna, Austria
| | - Paul Roschger
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1st Med. Dept. Hanusch Hospital, Vienna, Austria
| | - Hua Zhou
- Regional Bone Center and Clinical Research Center, Helen Hayes Hospital, West Haverstraw, NY, USA
| | - Jeri W Nieves
- Department of Epidemiology, Columbia University, New York, NY, USA.,Hospital for Special Surgery, New York, NY, USA
| | - Mathias Bostrom
- Regional Bone Center and Clinical Research Center, Helen Hayes Hospital, West Haverstraw, NY, USA.,Hospital for Special Surgery, New York, NY, USA
| | - Felicia Cosman
- Department of Medicine, Columbia University, New York, NY, USA
| | - Robert Lindsay
- Regional Bone Center and Clinical Research Center, Helen Hayes Hospital, West Haverstraw, NY, USA.,Department of Medicine, Columbia University, New York, NY, USA
| | - Klaus Klaushofer
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1st Med. Dept. Hanusch Hospital, Vienna, Austria
| | - David W Dempster
- Regional Bone Center and Clinical Research Center, Helen Hayes Hospital, West Haverstraw, NY, USA.,Department of Pathology and Cell Biology, Columbia University, New York, NY, USA
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30
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Cosman F, McMahon D, Dempster D, Nieves JW. Standard Versus Cyclic Teriparatide and Denosumab Treatment for Osteoporosis: A Randomized Trial. J Bone Miner Res 2020; 35:219-225. [PMID: 31419313 DOI: 10.1002/jbmr.3850] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 07/11/2019] [Accepted: 08/05/2019] [Indexed: 11/07/2022]
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 < 0.001 versus baseline). In the cyclic group, 36-month BMD increments were similar: LS 12%, TH 4%, FN 4%, and TBBM 4.1% (all p < 0.001 versus baseline). At 36 months, the LS BMD increase with standard was slightly larger than with cyclic (p = 0.04), but at 18 months, in the cyclic group, there was no decline in RAD or TBBM (p = 0.007 and < 0.001, respectively, versus standard). Although the cyclic regimen did not improve BMD compared with standard at 36 months, there appeared to be a benefit at 18 months, especially in the highly cortical skeletal sites. This could be clinically relevant in patients at high imminent risk of fracture, particularly at nonvertebral sites. © 2019 American Society for Bone and Mineral Research. © 2019 American Society for Bone and Mineral Research.
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Affiliation(s)
- Felicia Cosman
- Department of Medicine, Columbia University, New York, NY, USA
| | - Donald McMahon
- Clinical Research Center, Helen Hayes Hospital, West Haverstraw, NY, USA
| | - David Dempster
- Department of Pathology and Cell Biology, Columbia University, New York, NY, USA
| | - Jeri W Nieves
- Clinical Research Center, Helen Hayes Hospital, West Haverstraw, NY, USA
- Department of Epidemiology, Columbia University, New York, NY, USA
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Watts NB, Hattersley G, Fitzpatrick LA, Wang Y, Williams GC, Miller PD, Cosman F. Abaloparatide effect on forearm bone mineral density and wrist fracture risk in postmenopausal women with osteoporosis. Osteoporos Int 2019; 30:1187-1194. [PMID: 30899994 PMCID: PMC6546661 DOI: 10.1007/s00198-019-04890-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 01/31/2019] [Indexed: 10/31/2022]
Abstract
PURPOSE Wrist fractures are common, contribute significantly to morbidity in women with postmenopausal osteoporosis, and occur predominantly at the ultradistal radius, a site rich in trabecular bone. This exploratory analysis of the phase 3 ACTIVE study evaluated effects of abaloparatide versus placebo and teriparatide on forearm bone mineral density (BMD) and risk of wrist fracture. METHODS Forearm BMD was measured by dual energy X-ray absorptiometry in a subset of 982 women from ACTIVE, evenly distributed across the three treatment groups. Wrist fractures were ascertained in the total cohort (N = 2463). RESULTS After 18 months, ultradistal radius BMD changes from baseline were 2.25 percentage points greater for abaloparatide compared with placebo (95% confidence interval (CI) 1.38, 3.12, p < 0.001) and 1.54 percentage points greater for abaloparatide compared with teriparatide (95% CI 0.64, 2.45, p < 0.001). At 18 months, 1/3 radius BMD losses (versus baseline) were similar for abaloparatide compared with placebo (-0.42; 95% CI -1.03, 0.20; p = 0.19) but losses with teriparatide exceeded those of placebo (-1.66%; 95% CI -2.27, -1.06; p < 0.001). The decline with abaloparatide was less than that seen with teriparatide (group difference 1.22%; 95% CI 0.57, 1.87; p < 0.001). The radius BMD findings, at both ultradistal and 1/3 sites, are consistent with the numerically lower incidence of wrist fractures observed in women treated with abaloparatide compared with teriparatide (HR = 0.43; 95% CI 0.18, 1.03; p = 0.052) and placebo (HR = 0.49, 95% CI 0.20, 1.19, p = 0.11). CONCLUSIONS Compared with teriparatide, abaloparatide increased BMD at the ultradistal radius (primarily trabecular bone) and decreased BMD to a lesser extent at the 1/3 radius (primarily cortical bone), likely contributing to the numerically lower wrist fracture incidence observed with abaloparatide.
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Affiliation(s)
- N B Watts
- Mercy Health Osteoporosis and Bone Health Services, Cincinnati, OH, USA.
| | | | | | - Y Wang
- Radius Health, Inc., Waltham, MA, USA
| | | | - P D Miller
- Colorado Center for Bone Research, Lakewood, CO, USA
| | - F Cosman
- Columbia University College of Physicians and Surgeons, New York, NY, USA
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Ferrari S, Libanati C, Lin CJF, Brown JP, Cosman F, Czerwiński E, de Gregόrio LH, Malouf-Sierra J, Reginster JY, Wang A, Wagman RB, Lewiecki EM. Relationship Between Bone Mineral Density T-Score and Nonvertebral Fracture Risk Over 10 Years of Denosumab Treatment. J Bone Miner Res 2019; 34:1033-1040. [PMID: 30919997 PMCID: PMC6852155 DOI: 10.1002/jbmr.3722] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 02/15/2019] [Accepted: 02/22/2019] [Indexed: 01/08/2023]
Abstract
Although treat-to-target strategies are being discussed in osteoporosis, there is little evidence of what the target should be to reduce fracture risk maximally. We investigated the relationship between total hip BMD T-score and the incidence of nonvertebral fracture in women who received up to 10 years of continued denosumab therapy in the FREEDOM (3 years) study and its long-term Extension (up to 7 years) study. We report the percentages of women who achieved a range of T-scores at the total hip or femoral neck over 10 years of denosumab treatment (1343 women completed 10 years of treatment). The incidence of nonvertebral fractures was lower with higher total hip T-score. This relationship plateaued at a T-score between -2.0 and -1.5 and was independent of age and prevalent vertebral fractures, similar to observations in treatment-naïve subjects. Reaching a specific T-score during denosumab treatment was dependent on the baseline T-score, with higher T-scores at baseline more likely to result in higher T-scores at each time point during the study. Our findings highlight the importance of follow-up BMD measurements in patients receiving denosumab therapy because BMD remains a robust indicator of fracture risk. These data support the notion of a specific T-score threshold as a practical target for therapy in osteoporosis. © 2019 The Authors Journal of Bone and Mineral Research published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- S Ferrari
- Geneva University Hospital, Geneva, Switzerland
| | | | | | - J P Brown
- Laval University and CHU de Québec Research Centre, Quebec City, QC, Canada
| | | | | | - L H de Gregόrio
- Center for Clinical and Basic Research - Brasil, Rio de Janeiro, Brazil
| | | | | | - A Wang
- Amgen Inc., Thousand Oaks, CA, USA
| | | | - E M Lewiecki
- New Mexico Clinical Research & Osteoporosis Center, Albuquerque, NM, USA
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Kim TY, Bauer DC, McNabb BL, Schafer AL, Cosman F, Black DM, Eastell R. Comparison of BMD Changes and Bone Formation Marker Levels 3 Years After Bisphosphonate Discontinuation: FLEX and HORIZON-PFT Extension I Trials. J Bone Miner Res 2019; 34:810-816. [PMID: 30536713 PMCID: PMC10463267 DOI: 10.1002/jbmr.3654] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 11/26/2018] [Accepted: 11/28/2018] [Indexed: 11/06/2022]
Abstract
An ASBMR Task Force recommends a drug holiday for certain women treated for ≥5 years with oral alendronate or ≥3 years with intravenous zoledronic acid, with reassessment 2 to 3 years later. It is not known whether changes in bone mineral density (BMD) or bone turnover markers differ after oral or intravenous therapy. Our goal was to compare changes in BMD and procollagen type I N propeptide (PINP) after oral or intravenous bisphosphonate use. In the Fracture Intervention Trial Long-term Extension (FLEX), women who received a mean 5 years of alendronate were randomized to placebo or continued treatment. In the Health Outcomes and Reduced Incidence with Zoledronic Acid Once Yearly-Pivotal Fracture Trial Extension I (HORIZON-PFT E1), women who received 3 years of zoledronic acid were randomized to placebo or continued treatment. We examined the proportion of participants with BMD loss or PINP gain ≥ least significant change (LSC) and those whose values exceeded a threshold (T-score ≤-2.5 or PINP ≥36.0 ng/mL, a premenopausal median value). After 3 years of placebo, the FLEX group had greater mean total hip BMD decreases (-2.3% versus -1.2% in the HORIZON-PFT E1 group, p < 0.01) and greater rises in PINP (+11.6 ng/mL versus +6.7 ng/mL, p < 0.01). There was a greater proportion of individuals in FLEX with total hip BMD loss and PINP increases that exceeded LSC, and PINP values ≥36.0 ng/mL. In contrast, there were small changes in the proportion of women with femoral neck T-scores ≤-2.5 in both groups. In conclusion, 3 years after bisphosphonate discontinuation, a considerable proportion of former alendronate and zoledronic acid users had meaningful declines in total hip BMD and elevations in PINP. Despite a longer treatment course, alendronate may have a more rapid offset of drug effect than zoledronic acid. © 2018 American Society for Bone and Mineral Research.
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Affiliation(s)
- Tiffany Y Kim
- Department of Medicine, University of California, San Francisco, CA, USA
- Medical Service, San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
| | - Douglas C Bauer
- Department of Medicine, University of California, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Brian L McNabb
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Anne L Schafer
- Department of Medicine, University of California, San Francisco, CA, USA
- Medical Service, San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Felicia Cosman
- Department of Clinical Medicine, Columbia University, New York, NY, USA
- Clinical Research Center, Helen Hayes Hospital, West Haverstraw, NY, USA
| | - Dennis M Black
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Richard Eastell
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
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Cosman F, Nieves JW, Roimisher C, Neubort S, McMahon DJ, Dempster DW, Lindsay R. Administration of teriparatide for four years cyclically compared to two years daily in treatment Naïve and alendronate treated women. Bone 2019; 120:246-253. [PMID: 30355512 DOI: 10.1016/j.bone.2018.10.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 10/19/2018] [Accepted: 10/19/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE We evaluated if equivalent doses of TPTD given cyclically over 4-years could increase BMD >2-years of daily TPTD in 2 cohorts of women; previously untreated (Rx-Naïve) and women previously treated with ALN (ALN-Rx). METHODS In Rx-Naïve, women were randomized to daily TPTD for 24 months (Daily; n = 23) or cyclic TPTD for 48 months (3 months on, 3 months off; Cyclic; n = 25). In ALN-Rx, women were randomized to continued ALN plus daily TPTD for 24 months, followed by ALN alone for 24 months (Daily; n = 21) or TPTD for 48 months (3 months on, 3 months off) while ALN was continued (Cyclic; n = 20). BMD (DXA) was measured at spine (LS), total hip (TH) and femoral neck (FN). The primary analysis compared 4 years of cyclic therapy to 2 years of daily therapy in RX-naïve and ALN-RX cohorts. RESULTS In Rx-Naïve, BMD changes at 24 months after Daily TPTD vs. 48 months after Cyclic TPTD were: LS 8.6% vs. 6.9%; TH 2.5% vs. 2.6%, and FN 1.6% vs. 2.2%. None of the BMD changes differed significantly between groups but all changes were significant over time within each group (p < 0.01 except for FN where p = 0.17 Daily; p = 0.09 Cyclic). In ALN-Rx, BMD changes at 24 months after Daily TPTD vs. 48 months after Cyclic TPTD were: LS 7.5% vs. 7.2%; TH 3.8% vs. 4.1%, and FN 3.2% vs. 2.5%. There were no differences between groups but all changes were significant within each group (p < 0.01). CONCLUSION The same cumulative dose of TPTD given cyclically for 4-years, does not increase BMD more than standard daily TPTD over 2-years in either Rx-Naïve or ALN-Rx women. TRIAL REGISTRATION NCT00668941.
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Affiliation(s)
- Felicia Cosman
- Regional Bone and Clinical Research Centers, Helen Hayes Hospital, West Haverstraw, NY 10993, United States of America; Department of Medicine, Columbia University, New York, NY 10032, United States of America.
| | - Jeri W Nieves
- Regional Bone and Clinical Research Centers, Helen Hayes Hospital, West Haverstraw, NY 10993, United States of America; Department of Epidemiology, Columbia University, New York, NY 10032, United States of America
| | - Catherine Roimisher
- Regional Bone and Clinical Research Centers, Helen Hayes Hospital, West Haverstraw, NY 10993, United States of America
| | - Simon Neubort
- Regional Bone and Clinical Research Centers, Helen Hayes Hospital, West Haverstraw, NY 10993, United States of America
| | - Donald J McMahon
- Regional Bone and Clinical Research Centers, Helen Hayes Hospital, West Haverstraw, NY 10993, United States of America
| | - David W Dempster
- Regional Bone and Clinical Research Centers, Helen Hayes Hospital, West Haverstraw, NY 10993, United States of America; Department of Pathology and Cell Biology, Columbia University, New York, NY 10032, United States of America
| | - Robert Lindsay
- Regional Bone and Clinical Research Centers, Helen Hayes Hospital, West Haverstraw, NY 10993, United States of America; Department of Medicine, Columbia University, New York, NY 10032, United States of America
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Cosman F, Crittenden DB, Ferrari S, Lewiecki EM, Jaller-Raad J, Zerbini C, Milmont CE, Meisner PD, Libanati C, Grauer A. Romosozumab FRAME Study: A Post Hoc Analysis of the Role of Regional Background Fracture Risk on Nonvertebral Fracture Outcome. J Bone Miner Res 2018; 33:1407-1416. [PMID: 29750828 DOI: 10.1002/jbmr.3439] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 03/19/2018] [Accepted: 04/02/2018] [Indexed: 11/08/2022]
Abstract
In the pivotal Fracture Study in Postmenopausal Women with Osteoporosis (FRAME; NCT01575834), 1 year of the bone-forming agent romosozumab significantly reduced new vertebral and clinical fracture risk versus placebo. Nonvertebral fracture risk was not significantly reduced in the overall population, influenced by a low placebo-group fracture rate, observed particularly in the highest-enrolling region of Latin America. In year 1 of FRAME, postmenopausal women with a T-score of -2.5 to -3.5 at the total hip or femoral neck were randomized to subcutaneous romosozumab 210 mg or placebo once monthly for 12 months. Of 7180 randomized women, 43% were from Latin America, largely Colombia and Brazil. Prespecified analyses assessed fracture risk reductions by geographic regions. A significant treatment-by-geographic region interaction for the clinical (p = 0.029) and nonvertebral fracture (p = 0.042) endpoints led to further characterization of the Latin American population and comparison with the remaining study population, grouped post hoc as rest-of-world. Nonvertebral fracture efficacy in the overall population was also assessed by baseline fracture risk using the Fracture Risk Assessment Tool (FRAX). Romosozumab significantly and consistently reduced new vertebral fracture risk in Latin America (70% reduction; p = 0.014) and rest-of-world (74% reduction; p < 0.001). For nonvertebral fracture, risk reductions were observed in rest-of-world (42% reduction; p = 0.012), with no treatment effect observed in Latin America, where background nonvertebral fracture risk was low (1.2% in the placebo group). Consistent with this finding, in the overall population, greater reductions in nonvertebral fracture risk were observed among women with higher FRAX scores. These findings suggest that fracture risk assessment should consider regional factors in addition to classical risk factors, such as bone mineral density. In women at high risk for fracture, romosozumab reduced nonvertebral fracture risk within 1 year. © 2018 The Authors. Journal of Bone and Mineral Research Published by Wiley Periodicals, Inc.
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Affiliation(s)
- Felicia Cosman
- Helen Hayes Hospital, West Haverstraw, NY, USA, and Columbia University, New York, NY, USA
| | | | | | - E Michael Lewiecki
- New Mexico Clinical Research and Osteoporosis Center, Albuquerque, NM, USA
| | - Juan Jaller-Raad
- Division of Rheumatology, Centro de Reumatologia y Ortopedia, Barranquilla, Colombia
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Bone HG, Cosman F, Miller PD, Williams GC, Hattersley G, Hu MY, Fitzpatrick LA, Mitlak B, Papapoulos S, Rizzoli R, Dore RK, Bilezikian JP, Saag KG. ACTIVExtend: 24 Months of Alendronate After 18 Months of Abaloparatide or Placebo for Postmenopausal Osteoporosis. J Clin Endocrinol Metab 2018; 103:2949-2957. [PMID: 29800372 PMCID: PMC6097601 DOI: 10.1210/jc.2018-00163] [Citation(s) in RCA: 104] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 05/21/2018] [Indexed: 12/21/2022]
Abstract
PURPOSE In women with postmenopausal osteoporosis, we investigated the effects of 24 months of treatment with alendronate (ALN) following 18 months of treatment with abaloparatide (ABL) or placebo (PBO). METHODS Women who completed ABL or PBO treatment in ACTIVE were eligible to receive up to 24 months of ALN. We evaluated the incidence of vertebral and nonvertebral fractures and changes in bone mineral density (BMD) during the entire 43-month period from ACTIVE baseline to the end of ACTIVExtend and for the 24-month extension only. RESULTS Five hundred fifty-eight women from ACTIVE's ABL group and 581 from its PBO group (92% of ABL and PBO completers) were enrolled. During the full 43-month treatment period, 0.9% of evaluable women in the ABL/ALN group experienced a new radiographic vertebral fracture vs 5.6% of women in the PBO/ALN group, an 84% relative risk reduction (RRR, P < 0.001). Kaplan-Meier incidence rates for other reported fracture types were significantly lower for ABL/ALN vs PBO/ALN (all P < 0.05). Gains in BMD achieved during ACTIVE were further increased during ACTIVExtend. For ACTIVExtend only, RRR for vertebral fractures was 87% with ABL/ALN vs PBO/ALN (P = 0.001). Adverse events were similar between groups. A supplemental analysis for regulatory authorities found no hip fractures in the ABL/ALN group vs five in the PBO/ALN group. CONCLUSIONS Eighteen months of ABL followed by 24 months of ALN reduced the risk of vertebral, nonvertebral, clinical, and major osteoporotic fractures and increased BMD. Sequential ABL followed by ALN appears to be an effective treatment option for postmenopausal women at risk for osteoporosis-related fractures.
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Affiliation(s)
- Henry G Bone
- Michigan Bone and Mineral Clinic, P.C., Detroit, Michigan
- Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, Michigan
| | - Felicia Cosman
- Department of Clinical Medicine, Columbia University, New York, New York
- Clinical Research Center, Helen Hayes Hospital, West Haverstraw, New York
| | - Paul D Miller
- Colorado Center for Bone Research, Lakewood, Colorado
| | | | | | - Ming-yi Hu
- Radius Health, Inc., Waltham, Massachusetts
| | - Lorraine A Fitzpatrick
- Radius Health, Inc., Waltham, Massachusetts
- Correspondence and Reprint Requests: Lorraine A. Fitzpatrick, MD, Radius Health, Inc., 550 East Swedesford Road, Suite 370, Wayne, Pennsylvania 19087. E-mail:
| | | | - Socrates Papapoulos
- Center for Bone Quality, Leiden University Medical Center, ZA Leiden, Netherlands
| | - René Rizzoli
- Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Robin K Dore
- David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | - John P Bilezikian
- Division of Endocrinology, Columbia University College of Physicians and Surgeons, New York, New York
| | - Kenneth G Saag
- Division of Clinical Immunology and Rheumatology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
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Cosman F, Crittenden DB, Ferrari S, Khan A, Lane NE, Lippuner K, Matsumoto T, Milmont CE, Libanati C, Grauer A. FRAME Study: The Foundation Effect of Building Bone With 1 Year of Romosozumab Leads to Continued Lower Fracture Risk After Transition to Denosumab. J Bone Miner Res 2018; 33:1219-1226. [PMID: 29573473 DOI: 10.1002/jbmr.3427] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 03/08/2018] [Accepted: 03/15/2018] [Indexed: 11/06/2022]
Abstract
Romosozumab is a bone-forming agent with a dual effect of increasing bone formation and decreasing bone resorption. In FRActure study in postmenopausal woMen with ostEoporosis (FRAME), postmenopausal women with osteoporosis received romosozumab 210 mg s.c. or placebo once monthly for 12 months, followed by denosumab 60 mg s.c. once every 6 months in both groups for 12 months. One year of romosozumab increased spine and hip BMD by 13% and 7%, respectively, and reduced vertebral and clinical fractures with persistent fracture risk reduction upon transition to denosumab over 24 months. Here, we further characterize the BMD gains with romosozumab by quantifying the percentages of patients who responded at varying magnitudes; report the mean T-score changes from baseline over the 2-year study and contrast these results with the long-term BMD gains seen with denosumab during Fracture REduction Evaluation of Denosumab in Osteoporosis every 6 Months (FREEDOM) and its Extension studies; and assess fracture incidence rates in year 2, when all patients received denosumab. Among 7180 patients (n = 3591 placebo, n = 3589 romosozumab), most romosozumab-treated patients experienced ≥3% gains in BMD from baseline at month 12 (spine, 96%; hip, 78%) compared with placebo (spine, 22%; hip, 16%). For romosozumab patients, mean absolute T-score increases at the spine and hip were 0.88 and 0.32, respectively, at 12 months (placebo: 0.03 and 0.01) and 1.11 and 0.45 at 24 months (placebo-to-denosumab: 0.38 and 0.17), with the 2-year gains approximating the effect of 7 years of continuous denosumab administration. Patients receiving romosozumab versus placebo in year 1 had significantly fewer vertebral fractures in year 2 (81% relative reduction; p < 0.001), with fewer fractures consistently observed across other fracture categories. The data support the clinical benefit of rebuilding the skeletal foundation with romosozumab before transitioning to antiresorptive therapy. © 2018 The Authors. Journal of Bone and Mineral Research Published by Wiley Periodicals, Inc.
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Affiliation(s)
- Felicia Cosman
- Helen Hayes Hospital, West Haverstraw, NY, USA.,College of Physician and Surgeons, Columbia University, New York, NY, USA
| | | | | | - Aliya Khan
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Nancy E Lane
- Center for Musculoskeletal Health, UC Davis Medical Center, UC Davis, Sacramento, CA, USA
| | - Kurt Lippuner
- Department of Osteoporosis, Bern University Hospital, University of Bern, Switzerland
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Cosman F. Spine fracture prevalence in a nationally representative sample of US women and men aged ≥40 years: results from the National Health and Nutrition Examination Survey (NHANES) 2013-2014---supplementary presentation. Osteoporos Int 2017; 28:2319-2320. [PMID: 28695242 DOI: 10.1007/s00198-017-3999-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 03/06/2017] [Indexed: 10/19/2022]
Abstract
Spine fracture prevalence is similar in men and women, increasing from <5% in those <60 to 11% in those 70-79 and 18% in those ≥80 years. Prevalence was higher with age, lower bone mineral density (BMD), and in those meeting criteria for spine imaging. Most subjects with spine fractures were unaware of them.
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Affiliation(s)
- F Cosman
- Helen Hayes Hospital, Route 9W, West Haverstraw, New York, NY, 10993, USA.
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Cosman F, Krege JH, Looker AC, Schousboe JT, Fan B, Sarafrazi Isfahani N, Shepherd JA, Krohn KD, Steiger P, Wilson KE, Genant HK. Spine fracture prevalence in a nationally representative sample of US women and men aged ≥40 years: results from the National Health and Nutrition Examination Survey (NHANES) 2013-2014. Osteoporos Int 2017; 28:1857-1866. [PMID: 28175980 PMCID: PMC7422504 DOI: 10.1007/s00198-017-3948-9] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 01/26/2017] [Indexed: 12/13/2022]
Abstract
UNLABELLED Spine fracture prevalence is similar in men and women, increasing from <5 % in those <60 to 11 % in those 70-79 and 18 % in those ≥80 years. Prevalence was higher with age, lower bone mineral density (BMD), and in those meeting criteria for spine imaging. Most subjects with spine fractures were unaware of them. INTRODUCTION Spine fractures have substantial medical significance but are seldom recognized. This study collected contemporary nationally representative spine fracture prevalence data. METHODS Cross-sectional analysis of 3330 US adults aged ≥40 years participating in NHANES 2013-2014 with evaluable Vertebral Fracture Assessment (VFA). VFA was graded by semiquantitative measurement. BMD and an osteoporosis questionnaire were collected. RESULTS Overall spine fracture prevalence was 5.4 % and similar in men and women. Prevalence increased with age from <5 % in those <60 to 11 % in those 70-79 and 18 % in those ≥80 years. Fractures were more common in non-Hispanic whites and in people with lower body mass index and BMD. Among subjects with spine fracture, 26 % met BMD criteria for osteoporosis. Prevalence was higher in subjects who met National Osteoporosis Foundation (NOF) criteria for spine imaging (14 vs 4.7 %, P < 0.001). Only 8 % of people with a spine fracture diagnosed by VFA had a self-reported fracture, and among those who self-reported a spine fracture, only 21 % were diagnosed with fracture by VFA. CONCLUSION Spine fracture prevalence is similar in women and men and increases with age and lower BMD, although most subjects with spine fracture do not meet BMD criteria for osteoporosis. Since most (>90 %) individuals were unaware of their spine fractures, lateral spine imaging is needed to identify these women and men. Spine fracture prevalence was threefold higher in individuals meeting NOF criteria for spine imaging (∼1 in 7 undergoing VFA). Identifying spine fractures as part of comprehensive risk assessment may improve clinical decision making.
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Affiliation(s)
- F Cosman
- Regional Bone Center, Helen Hayes Hospital, Route 9W, West Haverstraw, NY, 10993, USA.
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA.
| | - J H Krege
- Eli Lilly and Company, Indianapolis, IN, USA
| | - A C Looker
- National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD, USA
| | - J T Schousboe
- HealthPartners Institute and Park Nicollet Clinic, HealthPartners, Minneapolis, MN, USA
| | - B Fan
- Department of Radiology, University of California, San Francisco, CA, USA
| | - N Sarafrazi Isfahani
- National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD, USA
| | - J A Shepherd
- Department of Radiology, University of California, San Francisco, CA, USA
| | - K D Krohn
- Eli Lilly and Company, Indianapolis, IN, USA
| | - P Steiger
- Parexel International, Waltham, MA, USA
| | | | - H K Genant
- Department of Radiology, University of California, San Francisco, CA, USA
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Affiliation(s)
- F Cosman
- Helen Hayes Hospital, 51-55 Route 9W North, West Haverstraw, NY, 10993, USA.
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Cosman F, Nieves JW, Dempster DW. Response to Letter to the Editor of JBMR: Treatment Sequence Matters. J Bone Miner Res 2017; 32:1148-1150. [PMID: 28294411 DOI: 10.1002/jbmr.3126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Felicia Cosman
- Professor of Medicine at Columbia University College of Physicians and Surgeons, Osteoporosis Specialist/Endocrinologist Helen Hayes Hospital Co-Editor in Chief, Osteoporosis International
| | - Jeri W Nieves
- Associate Professor of Clinical Epidemiology at Columbia University Mailman School of Public Health, Senior Research Scientist, Helen Hayes Hospital Associate Editor, Osteoporosis International
| | - David W Dempster
- Professor of Clinical Pathology and Cell Biology at Columbia University College of Physicians and Surgeons, Senior Research Scientist, Helen Hayes Hospital Associate Editor, Osteoporosis International
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Cosman F, Nieves JW, Dempster DW. Treatment Sequence Matters: Anabolic and Antiresorptive Therapy for Osteoporosis. J Bone Miner Res 2017; 32:198-202. [PMID: 27925287 DOI: 10.1002/jbmr.3051] [Citation(s) in RCA: 137] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 11/29/2016] [Accepted: 12/01/2016] [Indexed: 11/08/2022]
Abstract
The effects of anabolic medications (teriparatide [TPTD] and parathyroid hormone [PTH]) differ in patients who have received recent treatment with potent antiresorptives. This perspective reviews studies evaluating bone density (BMD) and histomorphometric effects of treatment sequences beginning with TPTD/PTH followed by potent antiresorptives and those beginning with potent antiresorptives followed by switching to or adding TPTD. Effect of treatment sequence on spine BMD outcome is minor, with modest quantitative differences. However, when individuals established on potent bisphosphonates are switched to TPTD, hip BMD declines below baseline for at least the first 12 months after the switch to TPTD. This transient hip BMD loss is more prominent when the antiresorptive is denosumab; in this setting, hip BMD remains below baseline for almost a full 24 months. In a controlled comparison of those who switched from alendronate to TPTD versus those who added TPTD to ongoing alendronate, the effect on hip BMD was improved with combination therapy. Furthermore, hip strength improved with the addition of TPTD to ongoing alendronate, whereas it was neutral after switching from alendronate to TPTD, primarily due to the effect on cortical bone. Bone biopsy studies indicate that TPTD stimulates bone formation in patients who have not been treated previously as well as in patients on prior and ongoing bisphosphonates. Histomorphometric evidence suggests that use of alendronate with TPTD blocks the TPTD-induced increase in cortical porosity. When possible, we suggest anabolic therapy first, followed by potent antiresorptive therapy. The common practice of switching to TPTD only after patients have an inadequate response to antiresorptives (intercurrent fracture or inadequate BMD effect) is not the optimal utilization of anabolic treatment. In fact, this may result in transient loss of hip BMD and strength. In this setting, continuing a potent antiresorptive while starting TPTD might improve hip outcomes. © 2017 American Society for Bone and Mineral Research.
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Affiliation(s)
- Felicia Cosman
- Regional Bone Center and Clinical Research Center, Helen Hayes Hospital, West Haverstraw, NY, USA.,Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Jeri W Nieves
- Regional Bone Center and Clinical Research Center, Helen Hayes Hospital, West Haverstraw, NY, USA.,Department of Epidemiology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - David W Dempster
- Regional Bone Center and Clinical Research Center, Helen Hayes Hospital, West Haverstraw, NY, USA.,Department of Pathology, Columbia University College of Physicians and Surgeons, New York, NY, USA
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Cosman F, Miller PD, Williams GC, Hattersley G, Hu MY, Valter I, Fitzpatrick LA, Riis BJ, Christiansen C, Bilezikian JP, Black D. Eighteen Months of Treatment With Subcutaneous Abaloparatide Followed by 6 Months of Treatment With Alendronate in Postmenopausal Women With Osteoporosis: Results of the ACTIVExtend Trial. Mayo Clin Proc 2017; 92:200-210. [PMID: 28160873 DOI: 10.1016/j.mayocp.2016.10.009] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 09/17/2016] [Accepted: 10/04/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To assess the efficacy and safety of 18 months of subcutaneous abaloparatide (ABL-SC) or placebo (PBO) followed by 6 months of alendronate (ALN) (preplanned interim analysis). PATIENTS AND METHODS ACTIVExtend, an extension of ACTIVE, enrolled patients who completed 18 months of ABL-SC or PBO in ACTIVE to receive up to 24 additional months of open-label ALN; there was 1 month between the studies to re-consent patients. RESULTS Of 1243 eligible ACTIVE patients, 1139 (92%) were enrolled in ACTIVExtend beginning November 20, 2012. These results are from a prespecified 6-month interim analysis (cutoff date, June 2, 2015); the study is ongoing. Findings indicated percentages of patients with new morphometric vertebral fractures: PBO/ALN, 4.4% vs ABL-SC/ALN, 0.55%; relative risk reduction, 87% (relative risk, 0.13; 95% CI, 0.04-0.41; P<.001). Kaplan-Meier estimated rates of nonvertebral fractures were PBO/ALN, 5.6% vs ABL-SC/ALN, 2.7%; risk reduction, 52% (hazard ratio [HR], 0.48; 95% CI, 0.26-0.89; log-rank P=.02). There was also a 58% risk reduction of major osteoporotic fractures (HR, 0.42; 95% CI, 0.21-0.85; log-rank P=.01) and a 45% risk reduction of clinical fractures (HR, 0.55; 95% CI, 0.33-0.92; log-rank P=.02) in the ABL-SC/ALN group vs the PBO/ALN group. At 25 months, bone mineral density percentage change from ACTIVE baseline for ABL-SC/ALN vs PBO/ALN was as follows: lumbar spine, 12.8%; total hip, 5.5%; femoral neck, 4.5% vs 3.5%, 1.4%, 0.5%, respectively (group differences at all sites P<.001). CONCLUSION Use of ABL-SC for 18 months followed by ALN for 6 months improved bone mineral density and reduced fracture risk throughout the skeleton and may be an effective treatment option for postmenopausal women with osteoporosis. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01657162.
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Affiliation(s)
- Felicia Cosman
- Department of Clinical Medicine, Columbia University, New York, NY; Clinical Research Center, Helen Hayes Hospital, West Haverstraw, NY.
| | | | | | | | | | - Ivo Valter
- Center for Clinical and Basic Research, Tallinn, Estonia
| | | | | | | | | | - Dennis Black
- University of California at San Francisco School of Medicine
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Cosman F, Hattersley G, Hu MY, Williams GC, Fitzpatrick LA, Black DM. Effects of Abaloparatide-SC on Fractures and Bone Mineral Density in Subgroups of Postmenopausal Women With Osteoporosis and Varying Baseline Risk Factors. J Bone Miner Res 2017; 32:17-23. [PMID: 27612281 DOI: 10.1002/jbmr.2991] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Revised: 08/30/2016] [Accepted: 09/01/2016] [Indexed: 11/06/2022]
Abstract
Abaloparatide-SC is a novel 34-amino acid peptide created to be a potent and selective activator of the parathyroid hormone receptor type 1 (PTHR1) signaling pathway. In the Abaloparatide Comparator Trial in Vertebral Endpoints (ACTIVE) Phase 3 trial (NCT01343004), abaloparatide reduced new morphometric vertebral fractures by 86% compared with placebo (p < 0.001) and nonvertebral fractures by 43% (p = 0.049) in postmenopausal women with osteoporosis. Abaloparatide-SC increased bone mineral density (BMD) 3.4% at the total hip, 2.9% at the femoral neck, and 9.2% at the lumbar spine at 18 months (all p < 0.001 versus placebo). The analysis reported here was designed to evaluate whether fracture risk reductions and BMD accrual were consistent across different levels of baseline risk. Risk factor subgroups were predefined categorically for BMD T-score of the lumbar spine, total hip, and femoral neck (≤-2.5 versus >-2.5 and ≤-3.0 versus >-3.0), history of nonvertebral fracture (yes versus no), prevalent vertebral fracture (yes versus no), and age (<65 versus 65 to <75 versus ≥75 years) at baseline. Forest plots show that there were no clinically meaningful interactions between any of the baseline risk factors and the treatment effect of abaloparatide-SC on new morphometric vertebral fractures, nonvertebral fractures, or BMD increases. Abaloparatide provides protection against fractures consistently across a wide variety of ages and baseline risks, including those with and without prior fractures, and it has potential utility for a broad group of postmenopausal women with osteoporosis. © 2016 American Society for Bone and Mineral Research.
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Affiliation(s)
- Felicia Cosman
- Columbia University, New York, NY, USA.,Clinical Research Center, Helen Hayes Hospital, West Haverstraw, NY, USA
| | | | | | | | | | - Dennis M Black
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
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Cummings SR, Cosman F, Lewiecki EM, Schousboe JT, Bauer DC, Black DM, Brown TD, Cheung AM, Cody K, Cooper C, Diez-Perez A, Eastell R, Hadji P, Hosoi T, Jan De Beur S, Kagan R, Kiel DP, Reid IR, Solomon DH, Randall S. Goal-Directed Treatment for Osteoporosis: A Progress Report From the ASBMR-NOF Working Group on Goal-Directed Treatment for Osteoporosis. J Bone Miner Res 2017; 32:3-10. [PMID: 27864889 DOI: 10.1002/jbmr.3039] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 10/10/2016] [Accepted: 11/11/2016] [Indexed: 12/13/2022]
Abstract
The American Society for Bone and Mineral Research and the United States National Osteoporosis Foundation (NOF) formed a working group to develop principles of goal-directed treatment and identify gaps that need to be filled to implement this approach. With goal-directed treatment, a treatment goal would first be established and choice of treatment determined by the probability of achieving that goal. Goals of treatment would be freedom from fracture, a T-score > -2.5, which is above the NOF threshold for initiating treatment, or achievement of an estimated risk level below the threshold for initiating treatment. Progress toward reaching the patient's goal would be periodically and systematically assessed by estimating the patient's compliance with treatment, reviewing fracture history, repeating vertebral imaging when indicated, and repeating measurement of bone mineral density (BMD). Using these data, a decision would be made to stop, continue, or change therapy. Some of these approaches can now be applied to clinical practice. However, the application of goal-directed treatment cannot be fully achieved until medications are available that provide greater increases in BMD and greater reduction in fracture risk than those that are currently approved; only then can patients with very high fracture risk and very low BMD achieve such goals. Furthermore, assessing future fracture risk in patients on treatment requires a new assessment tool that accurately captures the change in fracture risk associated with treatment and should also be sensitive to the importance of recent fractures as predictors of imminent fracture risk. Lastly, evidence is needed to confirm that selecting and switching treatments to achieve goals reduces fracture risk more effectively than current standard care. © 2016 American Society for Bone and Mineral Research.
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Affiliation(s)
- Steven R Cummings
- California Pacific Medical Center, Research Institute, San Francisco, CA, USA
| | - Felicia Cosman
- Helen Hayes Hospital and Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - E Michael Lewiecki
- New Mexico Clinical Research & Osteoporosis Center, Albuquerque, NM, USA
| | - John T Schousboe
- Park Nicollet Institute for Research and Education, Division of Rheumatology, Minneapolis, MN, USA
| | - Douglas C Bauer
- Departments of Medicine and Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Dennis M Black
- University of California, San Francisco, Department of Epidemiology and Biostatistics, San Francisco, CA, USA
| | - Thomas D Brown
- University of Iowa, Department of Orthopedics and Rehabilitation, Iowa City, IA, USA
| | | | - Kathleen Cody
- Foundation for Osteoporosis Research and Education, Oakland, CA, USA
| | - Cyrus Cooper
- University of Southampton, MRC Lifecourse Epidemiology Unit, Southhampton, United Kingdom
| | - Adolfo Diez-Perez
- Hospital del Mar-IMIM-Universitat Autònoma de Barcelona and RETICEF, Instituto Carlos III, Spain, Internal Medicine - Infectious Diseases, Barcelona, Spain
| | - Richard Eastell
- University of Sheffield, Human Metabolism, England, United Kingdom
| | - Peyman Hadji
- Philipps-University of Marburg, Department of Endocrinology, Osteoporosis, and Reproductive Medicine, Marburg, Germany
| | - Takayuki Hosoi
- National Center for Geriatrics and Gerontology, Obu City, Aichi Prefecture, Japan
| | | | - Risa Kagan
- University of California, San Francisco, San Francisco, CA, USA
| | - Douglas P Kiel
- Hebrew SeniorLife, Institute for Aging Research, Boston, MA, USA
| | - Ian R Reid
- University of Auckland, Department of Medicine, Auckland, New Zealand
| | - Daniel H Solomon
- Brigham and Women's Hospital, Division of Rheumatology, Boston, MA, USA
| | - Susan Randall
- National Osteoporosis Foundation, Arlington, VA, USA
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Cosman F, Crittenden DB, Adachi JD, Binkley N, Czerwinski E, Ferrari S, Hofbauer LC, Lau E, Lewiecki EM, Miyauchi A, Zerbini CAF, Milmont CE, Chen L, Maddox J, Meisner PD, Libanati C, Grauer A. Romosozumab Treatment in Postmenopausal Women with Osteoporosis. N Engl J Med 2016; 375:1532-1543. [PMID: 27641143 DOI: 10.1056/nejmoa1607948] [Citation(s) in RCA: 875] [Impact Index Per Article: 109.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Romosozumab, a monoclonal antibody that binds sclerostin, increases bone formation and decreases bone resorption. METHODS We enrolled 7180 postmenopausal women who had a T score of -2.5 to -3.5 at the total hip or femoral neck. Patients were randomly assigned to receive subcutaneous injections of romosozumab (at a dose of 210 mg) or placebo monthly for 12 months; thereafter, patients in each group received denosumab for 12 months, at a dose of 60 mg, administered subcutaneously every 6 months. The coprimary end points were the cumulative incidences of new vertebral fractures at 12 months and 24 months. Secondary end points included clinical (a composite of nonvertebral and symptomatic vertebral) and nonvertebral fractures. RESULTS At 12 months, new vertebral fractures had occurred in 16 of 3321 patients (0.5%) in the romosozumab group, as compared with 59 of 3322 (1.8%) in the placebo group (representing a 73% lower risk with romosozumab; P<0.001). Clinical fractures had occurred in 58 of 3589 patients (1.6%) in the romosozumab group, as compared with 90 of 3591 (2.5%) in the placebo group (a 36% lower risk with romosozumab; P=0.008). Nonvertebral fractures had occurred in 56 of 3589 patients (1.6%) in the romosozumab group and in 75 of 3591 (2.1%) in the placebo group (P=0.10). At 24 months, the rates of vertebral fractures were significantly lower in the romosozumab group than in the placebo group after each group made the transition to denosumab (0.6% [21 of 3325 patients] in the romosozumab group vs. 2.5% [84 of 3327] in the placebo group, a 75% lower risk with romosozumab; P<0.001). Adverse events, including instances of hyperostosis, cardiovascular events, osteoarthritis, and cancer, appeared to be balanced between the groups. One atypical femoral fracture and two cases of osteonecrosis of the jaw were observed in the romosozumab group. CONCLUSIONS In postmenopausal women with osteoporosis, romosozumab was associated with a lower risk of vertebral fracture than placebo at 12 months and, after the transition to denosumab, at 24 months. The lower risk of clinical fracture that was seen with romosozumab was evident at 1 year. (Funded by Amgen and UCB Pharma; FRAME ClinicalTrials.gov number, NCT01575834 .).
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Affiliation(s)
- Felicia Cosman
- From Helen Hayes Hospital, West Haverstraw, and Columbia University, New York (F.C.) - both in New York; Amgen, Thousand Oaks, CA (D.B.C., C.E.M., L.C., J.M., A.G.); McMaster University, Hamilton, ON, Canada (J.D.A.); University of Wisconsin-Madison Osteoporosis Clinical Center and Research Program, Madison (N.B.); Krakow Medical Center, Krakow, Poland (E.C.); Geneva University Hospital, Geneva (S.F.); the Division of Endocrinology, Diabetes, and Bone Diseases, Center for Healthy Aging, Technische Universität Dresden Medical Center, Dresden, Germany (L.C.H.); the Center for Clinical and Basic Research, Hong Kong (E.L.); New Mexico Clinical Research and Osteoporosis Center, Albuquerque (E.M.L.); Miyauchi Medical Center, Osaka, Japan (A.M.); Centro Paulista de Investigação Clinica, São Paulo (C.A.F.Z.); and UCB Pharma, Brussels (P.D.M., C.L.)
| | - Daria B Crittenden
- From Helen Hayes Hospital, West Haverstraw, and Columbia University, New York (F.C.) - both in New York; Amgen, Thousand Oaks, CA (D.B.C., C.E.M., L.C., J.M., A.G.); McMaster University, Hamilton, ON, Canada (J.D.A.); University of Wisconsin-Madison Osteoporosis Clinical Center and Research Program, Madison (N.B.); Krakow Medical Center, Krakow, Poland (E.C.); Geneva University Hospital, Geneva (S.F.); the Division of Endocrinology, Diabetes, and Bone Diseases, Center for Healthy Aging, Technische Universität Dresden Medical Center, Dresden, Germany (L.C.H.); the Center for Clinical and Basic Research, Hong Kong (E.L.); New Mexico Clinical Research and Osteoporosis Center, Albuquerque (E.M.L.); Miyauchi Medical Center, Osaka, Japan (A.M.); Centro Paulista de Investigação Clinica, São Paulo (C.A.F.Z.); and UCB Pharma, Brussels (P.D.M., C.L.)
| | - Jonathan D Adachi
- From Helen Hayes Hospital, West Haverstraw, and Columbia University, New York (F.C.) - both in New York; Amgen, Thousand Oaks, CA (D.B.C., C.E.M., L.C., J.M., A.G.); McMaster University, Hamilton, ON, Canada (J.D.A.); University of Wisconsin-Madison Osteoporosis Clinical Center and Research Program, Madison (N.B.); Krakow Medical Center, Krakow, Poland (E.C.); Geneva University Hospital, Geneva (S.F.); the Division of Endocrinology, Diabetes, and Bone Diseases, Center for Healthy Aging, Technische Universität Dresden Medical Center, Dresden, Germany (L.C.H.); the Center for Clinical and Basic Research, Hong Kong (E.L.); New Mexico Clinical Research and Osteoporosis Center, Albuquerque (E.M.L.); Miyauchi Medical Center, Osaka, Japan (A.M.); Centro Paulista de Investigação Clinica, São Paulo (C.A.F.Z.); and UCB Pharma, Brussels (P.D.M., C.L.)
| | - Neil Binkley
- From Helen Hayes Hospital, West Haverstraw, and Columbia University, New York (F.C.) - both in New York; Amgen, Thousand Oaks, CA (D.B.C., C.E.M., L.C., J.M., A.G.); McMaster University, Hamilton, ON, Canada (J.D.A.); University of Wisconsin-Madison Osteoporosis Clinical Center and Research Program, Madison (N.B.); Krakow Medical Center, Krakow, Poland (E.C.); Geneva University Hospital, Geneva (S.F.); the Division of Endocrinology, Diabetes, and Bone Diseases, Center for Healthy Aging, Technische Universität Dresden Medical Center, Dresden, Germany (L.C.H.); the Center for Clinical and Basic Research, Hong Kong (E.L.); New Mexico Clinical Research and Osteoporosis Center, Albuquerque (E.M.L.); Miyauchi Medical Center, Osaka, Japan (A.M.); Centro Paulista de Investigação Clinica, São Paulo (C.A.F.Z.); and UCB Pharma, Brussels (P.D.M., C.L.)
| | - Edward Czerwinski
- From Helen Hayes Hospital, West Haverstraw, and Columbia University, New York (F.C.) - both in New York; Amgen, Thousand Oaks, CA (D.B.C., C.E.M., L.C., J.M., A.G.); McMaster University, Hamilton, ON, Canada (J.D.A.); University of Wisconsin-Madison Osteoporosis Clinical Center and Research Program, Madison (N.B.); Krakow Medical Center, Krakow, Poland (E.C.); Geneva University Hospital, Geneva (S.F.); the Division of Endocrinology, Diabetes, and Bone Diseases, Center for Healthy Aging, Technische Universität Dresden Medical Center, Dresden, Germany (L.C.H.); the Center for Clinical and Basic Research, Hong Kong (E.L.); New Mexico Clinical Research and Osteoporosis Center, Albuquerque (E.M.L.); Miyauchi Medical Center, Osaka, Japan (A.M.); Centro Paulista de Investigação Clinica, São Paulo (C.A.F.Z.); and UCB Pharma, Brussels (P.D.M., C.L.)
| | - Serge Ferrari
- From Helen Hayes Hospital, West Haverstraw, and Columbia University, New York (F.C.) - both in New York; Amgen, Thousand Oaks, CA (D.B.C., C.E.M., L.C., J.M., A.G.); McMaster University, Hamilton, ON, Canada (J.D.A.); University of Wisconsin-Madison Osteoporosis Clinical Center and Research Program, Madison (N.B.); Krakow Medical Center, Krakow, Poland (E.C.); Geneva University Hospital, Geneva (S.F.); the Division of Endocrinology, Diabetes, and Bone Diseases, Center for Healthy Aging, Technische Universität Dresden Medical Center, Dresden, Germany (L.C.H.); the Center for Clinical and Basic Research, Hong Kong (E.L.); New Mexico Clinical Research and Osteoporosis Center, Albuquerque (E.M.L.); Miyauchi Medical Center, Osaka, Japan (A.M.); Centro Paulista de Investigação Clinica, São Paulo (C.A.F.Z.); and UCB Pharma, Brussels (P.D.M., C.L.)
| | - Lorenz C Hofbauer
- From Helen Hayes Hospital, West Haverstraw, and Columbia University, New York (F.C.) - both in New York; Amgen, Thousand Oaks, CA (D.B.C., C.E.M., L.C., J.M., A.G.); McMaster University, Hamilton, ON, Canada (J.D.A.); University of Wisconsin-Madison Osteoporosis Clinical Center and Research Program, Madison (N.B.); Krakow Medical Center, Krakow, Poland (E.C.); Geneva University Hospital, Geneva (S.F.); the Division of Endocrinology, Diabetes, and Bone Diseases, Center for Healthy Aging, Technische Universität Dresden Medical Center, Dresden, Germany (L.C.H.); the Center for Clinical and Basic Research, Hong Kong (E.L.); New Mexico Clinical Research and Osteoporosis Center, Albuquerque (E.M.L.); Miyauchi Medical Center, Osaka, Japan (A.M.); Centro Paulista de Investigação Clinica, São Paulo (C.A.F.Z.); and UCB Pharma, Brussels (P.D.M., C.L.)
| | - Edith Lau
- From Helen Hayes Hospital, West Haverstraw, and Columbia University, New York (F.C.) - both in New York; Amgen, Thousand Oaks, CA (D.B.C., C.E.M., L.C., J.M., A.G.); McMaster University, Hamilton, ON, Canada (J.D.A.); University of Wisconsin-Madison Osteoporosis Clinical Center and Research Program, Madison (N.B.); Krakow Medical Center, Krakow, Poland (E.C.); Geneva University Hospital, Geneva (S.F.); the Division of Endocrinology, Diabetes, and Bone Diseases, Center for Healthy Aging, Technische Universität Dresden Medical Center, Dresden, Germany (L.C.H.); the Center for Clinical and Basic Research, Hong Kong (E.L.); New Mexico Clinical Research and Osteoporosis Center, Albuquerque (E.M.L.); Miyauchi Medical Center, Osaka, Japan (A.M.); Centro Paulista de Investigação Clinica, São Paulo (C.A.F.Z.); and UCB Pharma, Brussels (P.D.M., C.L.)
| | - E Michael Lewiecki
- From Helen Hayes Hospital, West Haverstraw, and Columbia University, New York (F.C.) - both in New York; Amgen, Thousand Oaks, CA (D.B.C., C.E.M., L.C., J.M., A.G.); McMaster University, Hamilton, ON, Canada (J.D.A.); University of Wisconsin-Madison Osteoporosis Clinical Center and Research Program, Madison (N.B.); Krakow Medical Center, Krakow, Poland (E.C.); Geneva University Hospital, Geneva (S.F.); the Division of Endocrinology, Diabetes, and Bone Diseases, Center for Healthy Aging, Technische Universität Dresden Medical Center, Dresden, Germany (L.C.H.); the Center for Clinical and Basic Research, Hong Kong (E.L.); New Mexico Clinical Research and Osteoporosis Center, Albuquerque (E.M.L.); Miyauchi Medical Center, Osaka, Japan (A.M.); Centro Paulista de Investigação Clinica, São Paulo (C.A.F.Z.); and UCB Pharma, Brussels (P.D.M., C.L.)
| | - Akimitsu Miyauchi
- From Helen Hayes Hospital, West Haverstraw, and Columbia University, New York (F.C.) - both in New York; Amgen, Thousand Oaks, CA (D.B.C., C.E.M., L.C., J.M., A.G.); McMaster University, Hamilton, ON, Canada (J.D.A.); University of Wisconsin-Madison Osteoporosis Clinical Center and Research Program, Madison (N.B.); Krakow Medical Center, Krakow, Poland (E.C.); Geneva University Hospital, Geneva (S.F.); the Division of Endocrinology, Diabetes, and Bone Diseases, Center for Healthy Aging, Technische Universität Dresden Medical Center, Dresden, Germany (L.C.H.); the Center for Clinical and Basic Research, Hong Kong (E.L.); New Mexico Clinical Research and Osteoporosis Center, Albuquerque (E.M.L.); Miyauchi Medical Center, Osaka, Japan (A.M.); Centro Paulista de Investigação Clinica, São Paulo (C.A.F.Z.); and UCB Pharma, Brussels (P.D.M., C.L.)
| | - Cristiano A F Zerbini
- From Helen Hayes Hospital, West Haverstraw, and Columbia University, New York (F.C.) - both in New York; Amgen, Thousand Oaks, CA (D.B.C., C.E.M., L.C., J.M., A.G.); McMaster University, Hamilton, ON, Canada (J.D.A.); University of Wisconsin-Madison Osteoporosis Clinical Center and Research Program, Madison (N.B.); Krakow Medical Center, Krakow, Poland (E.C.); Geneva University Hospital, Geneva (S.F.); the Division of Endocrinology, Diabetes, and Bone Diseases, Center for Healthy Aging, Technische Universität Dresden Medical Center, Dresden, Germany (L.C.H.); the Center for Clinical and Basic Research, Hong Kong (E.L.); New Mexico Clinical Research and Osteoporosis Center, Albuquerque (E.M.L.); Miyauchi Medical Center, Osaka, Japan (A.M.); Centro Paulista de Investigação Clinica, São Paulo (C.A.F.Z.); and UCB Pharma, Brussels (P.D.M., C.L.)
| | - Cassandra E Milmont
- From Helen Hayes Hospital, West Haverstraw, and Columbia University, New York (F.C.) - both in New York; Amgen, Thousand Oaks, CA (D.B.C., C.E.M., L.C., J.M., A.G.); McMaster University, Hamilton, ON, Canada (J.D.A.); University of Wisconsin-Madison Osteoporosis Clinical Center and Research Program, Madison (N.B.); Krakow Medical Center, Krakow, Poland (E.C.); Geneva University Hospital, Geneva (S.F.); the Division of Endocrinology, Diabetes, and Bone Diseases, Center for Healthy Aging, Technische Universität Dresden Medical Center, Dresden, Germany (L.C.H.); the Center for Clinical and Basic Research, Hong Kong (E.L.); New Mexico Clinical Research and Osteoporosis Center, Albuquerque (E.M.L.); Miyauchi Medical Center, Osaka, Japan (A.M.); Centro Paulista de Investigação Clinica, São Paulo (C.A.F.Z.); and UCB Pharma, Brussels (P.D.M., C.L.)
| | - Li Chen
- From Helen Hayes Hospital, West Haverstraw, and Columbia University, New York (F.C.) - both in New York; Amgen, Thousand Oaks, CA (D.B.C., C.E.M., L.C., J.M., A.G.); McMaster University, Hamilton, ON, Canada (J.D.A.); University of Wisconsin-Madison Osteoporosis Clinical Center and Research Program, Madison (N.B.); Krakow Medical Center, Krakow, Poland (E.C.); Geneva University Hospital, Geneva (S.F.); the Division of Endocrinology, Diabetes, and Bone Diseases, Center for Healthy Aging, Technische Universität Dresden Medical Center, Dresden, Germany (L.C.H.); the Center for Clinical and Basic Research, Hong Kong (E.L.); New Mexico Clinical Research and Osteoporosis Center, Albuquerque (E.M.L.); Miyauchi Medical Center, Osaka, Japan (A.M.); Centro Paulista de Investigação Clinica, São Paulo (C.A.F.Z.); and UCB Pharma, Brussels (P.D.M., C.L.)
| | - Judy Maddox
- From Helen Hayes Hospital, West Haverstraw, and Columbia University, New York (F.C.) - both in New York; Amgen, Thousand Oaks, CA (D.B.C., C.E.M., L.C., J.M., A.G.); McMaster University, Hamilton, ON, Canada (J.D.A.); University of Wisconsin-Madison Osteoporosis Clinical Center and Research Program, Madison (N.B.); Krakow Medical Center, Krakow, Poland (E.C.); Geneva University Hospital, Geneva (S.F.); the Division of Endocrinology, Diabetes, and Bone Diseases, Center for Healthy Aging, Technische Universität Dresden Medical Center, Dresden, Germany (L.C.H.); the Center for Clinical and Basic Research, Hong Kong (E.L.); New Mexico Clinical Research and Osteoporosis Center, Albuquerque (E.M.L.); Miyauchi Medical Center, Osaka, Japan (A.M.); Centro Paulista de Investigação Clinica, São Paulo (C.A.F.Z.); and UCB Pharma, Brussels (P.D.M., C.L.)
| | - Paul D Meisner
- From Helen Hayes Hospital, West Haverstraw, and Columbia University, New York (F.C.) - both in New York; Amgen, Thousand Oaks, CA (D.B.C., C.E.M., L.C., J.M., A.G.); McMaster University, Hamilton, ON, Canada (J.D.A.); University of Wisconsin-Madison Osteoporosis Clinical Center and Research Program, Madison (N.B.); Krakow Medical Center, Krakow, Poland (E.C.); Geneva University Hospital, Geneva (S.F.); the Division of Endocrinology, Diabetes, and Bone Diseases, Center for Healthy Aging, Technische Universität Dresden Medical Center, Dresden, Germany (L.C.H.); the Center for Clinical and Basic Research, Hong Kong (E.L.); New Mexico Clinical Research and Osteoporosis Center, Albuquerque (E.M.L.); Miyauchi Medical Center, Osaka, Japan (A.M.); Centro Paulista de Investigação Clinica, São Paulo (C.A.F.Z.); and UCB Pharma, Brussels (P.D.M., C.L.)
| | - Cesar Libanati
- From Helen Hayes Hospital, West Haverstraw, and Columbia University, New York (F.C.) - both in New York; Amgen, Thousand Oaks, CA (D.B.C., C.E.M., L.C., J.M., A.G.); McMaster University, Hamilton, ON, Canada (J.D.A.); University of Wisconsin-Madison Osteoporosis Clinical Center and Research Program, Madison (N.B.); Krakow Medical Center, Krakow, Poland (E.C.); Geneva University Hospital, Geneva (S.F.); the Division of Endocrinology, Diabetes, and Bone Diseases, Center for Healthy Aging, Technische Universität Dresden Medical Center, Dresden, Germany (L.C.H.); the Center for Clinical and Basic Research, Hong Kong (E.L.); New Mexico Clinical Research and Osteoporosis Center, Albuquerque (E.M.L.); Miyauchi Medical Center, Osaka, Japan (A.M.); Centro Paulista de Investigação Clinica, São Paulo (C.A.F.Z.); and UCB Pharma, Brussels (P.D.M., C.L.)
| | - Andreas Grauer
- From Helen Hayes Hospital, West Haverstraw, and Columbia University, New York (F.C.) - both in New York; Amgen, Thousand Oaks, CA (D.B.C., C.E.M., L.C., J.M., A.G.); McMaster University, Hamilton, ON, Canada (J.D.A.); University of Wisconsin-Madison Osteoporosis Clinical Center and Research Program, Madison (N.B.); Krakow Medical Center, Krakow, Poland (E.C.); Geneva University Hospital, Geneva (S.F.); the Division of Endocrinology, Diabetes, and Bone Diseases, Center for Healthy Aging, Technische Universität Dresden Medical Center, Dresden, Germany (L.C.H.); the Center for Clinical and Basic Research, Hong Kong (E.L.); New Mexico Clinical Research and Osteoporosis Center, Albuquerque (E.M.L.); Miyauchi Medical Center, Osaka, Japan (A.M.); Centro Paulista de Investigação Clinica, São Paulo (C.A.F.Z.); and UCB Pharma, Brussels (P.D.M., C.L.)
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Miller PD, Hattersley G, Riis BJ, Williams GC, Lau E, Russo LA, Alexandersen P, Zerbini CAF, Hu MY, Harris AG, Fitzpatrick LA, Cosman F, Christiansen C. Effect of Abaloparatide vs Placebo on New Vertebral Fractures in Postmenopausal Women With Osteoporosis: A Randomized Clinical Trial. JAMA 2016; 316:722-33. [PMID: 27533157 DOI: 10.1001/jama.2016.11136] [Citation(s) in RCA: 491] [Impact Index Per Article: 61.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
IMPORTANCE Additional therapies are needed for prevention of osteoporotic fractures. Abaloparatide is a selective activator of the parathyroid hormone type 1 receptor. OBJECTIVE To determine the efficacy and safety of abaloparatide, 80 μg, vs placebo for prevention of new vertebral fracture in postmenopausal women at risk of osteoporotic fracture. DESIGN, SETTING, AND PARTICIPANTS The Abaloparatide Comparator Trial In Vertebral Endpoints (ACTIVE) was a phase 3, double-blind, RCT (March 2011-October 2014) at 28 sites in 10 countries. Postmenopausal women with bone mineral density (BMD) T score ≤-2.5 and >-5.0 at the lumbar spine or femoral neck and radiological evidence ≥2 mild or ≥1 moderate lumbar or thoracic vertebral fracture or history of low-trauma nonvertebral fracture within the past 5 years were eligible. Postmenopausal women (>65 y) with fracture criteria and a T score ≤-2.0 and >-5.0 or without fracture criteria and a T score ≤-3.0 and >-5.0 could enroll. INTERVENTIONS Blinded, daily subcutaneous injections of placebo (n = 821); abaloparatide, 80 μg (n = 824); or open-label teriparatide, 20 μg (n = 818) for 18 months. MAIN OUTCOMES AND MEASURES Primary end point was percentage of participants with new vertebral fracture in the abaloparatide vs placebo groups. Sample size was set to detect a 4% difference (57% risk reduction) between treatment groups. Secondary end points included change in BMD at total hip, femoral neck, and lumbar spine in abaloparatide-treated vs placebo participants and time to first incident nonvertebral fracture. Hypercalcemia was a prespecified safety end point in abaloparatide-treated vs teriparatide participants. RESULTS Among 2463 women (mean age, 69 years [range, 49-86]), 1901 completed the study. New morphometric vertebral fractures occurred less frequently in the active treatment groups vs placebo. The Kaplan-Meier estimated event rate for nonvertebral fracture was lower with abaloparatide vs placebo. BMD increases were greater with abaloparatide than placebo (all P < .001). Incidence of hypercalcemia was lower with abaloparatide (3.4%) vs teriparatide (6.4%) (risk difference [RD], −2.96 [95%CI, −5.12 to −0.87]; P = .006). [table: see text]. CONCLUSIONS AND RELEVANCE Among postmenopausal women with osteoporosis, the use of subcutaneous abaloparatide, compared with placebo, reduced the risk of new vertebral and nonvertebral fractures over 18 months. Further research is needed to understand the clinical importance of RD, the risks and benefits of abaloparatide treatment, and the efficacy of abaloparatide vs other osteoporosis treatments. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01343004.
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Affiliation(s)
| | | | | | | | - Edith Lau
- Center for Health & Medical Research, Hong Kong, People's Republic of China
| | | | | | | | | | | | | | - Felicia Cosman
- Clinical Research Center, Helen Hayes Hospital, West Haverstraw, New York
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50
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Dempster DW, Cosman F, Zhou H, Nieves JW, Bostrom M, Lindsay R. Effects of Daily or Cyclic Teriparatide on Bone Formation in the Iliac Crest in Women on No Prior Therapy and in Women on Alendronate. J Bone Miner Res 2016; 31:1518-26. [PMID: 26916877 DOI: 10.1002/jbmr.2822] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 02/08/2016] [Accepted: 02/22/2016] [Indexed: 11/08/2022]
Abstract
There is little information on the effects of combination therapy for osteoporosis at the tissue level. Using quadruple tetracycline-labeled bone biopsies, we have compared the bone formation response to teriparatide (TPTD) in treatment-naïve subjects (Rx-Naïve) and in subjects on prior and ongoing alendronate (ALN) treatment (ALN-Rx). Three bone envelopes were analyzed: cancellous, endocortical, and intracortical. TPTD was given as a standard, continuous daily injection or as a cyclic regimen (3 months on daily TPTD, 3 months off, 3 months on daily TPTD). Subjects were biopsied at 7 weeks and at 7 months to allow comparison of the bone formation response to the first and second cycles of TPTD. Baseline values for dynamic bone formation indices were lower in ALN-Rx than Rx-Naïve subjects. Both Rx-Naïve and ALN-RX subjects responded to TPTD with significant increases in bone formation indices at both time points. With cyclic TPTD treatment, the first and second cycles of TPTD stimulated bone formation rate in the cancellous and endocortical envelopes to a similar extent in ALN-Rx and Rx-Naïve subjects. However, in Rx-Naïve patients, bone formation rate (BFR/BS) was higher in patients receiving daily treatment compared with those receiving cyclic TPTD treatment in all three envelopes in the 7-month biopsies. This suggests that the cyclic approach does not provide a skeletal benefit in treatment-naive patients. In the 7-month biopsies, cortical porosity was higher in the Rx-Naïve group receiving daily TPTD than in all other groups. These data provide supporting evidence at the tissue level for previous biochemical and densitometric data suggesting that addition of either cyclic or daily TPTD to ongoing ALN treatment may be an effective approach for patients with severe osteoporosis already treated with ALN who remain at high risk of fracture. © 2016 American Society for Bone and Mineral Research.
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Affiliation(s)
- David W Dempster
- Regional Bone Center and Clinical Research Center, Helen Hayes Hospital, West Haverstraw, NY, USA.,Department of Pathology and Cell Biology, Columbia University, New York, NY, USA
| | - Felicia Cosman
- Regional Bone Center and Clinical Research Center, Helen Hayes Hospital, West Haverstraw, NY, USA.,Department of Medicine, Columbia University, New York, NY, USA
| | - Hua Zhou
- Regional Bone Center and Clinical Research Center, Helen Hayes Hospital, West Haverstraw, NY, USA
| | - Jeri W Nieves
- Regional Bone Center and Clinical Research Center, Helen Hayes Hospital, West Haverstraw, NY, USA.,Department of Epidemiology, Columbia University, New York, NY, USA
| | - Mathias Bostrom
- Regional Bone Center and Clinical Research Center, Helen Hayes Hospital, West Haverstraw, NY, USA.,Hospital for Special Surgery, New York, NY, USA
| | - Robert Lindsay
- Regional Bone Center and Clinical Research Center, Helen Hayes Hospital, West Haverstraw, NY, USA.,Department of Medicine, Columbia University, New York, NY, USA
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