Teriparatide vs. Risedronate in Hip Fractures in elder patients

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Teriparatide vs. Risedronate in Hip Fractures in elder patients

With growing age, the number of defects and health issues also increase. One of such defect is the hip fracture that begins due to weak bones. In hip fractures, pertrochanteric is very common among older people. Pertochanteric fracture develops in femur that passes through greater trochanter and this can recover through surgery. The medications like teriparatide or risedronate are best suited for this action; however, the best approach among these is yet to be confirmed.

To evaluate the effect of teriparatide vs. risedronate on bones in older patients, a comparable study was executed within 2 weeks after the surgery. The teriparatide 20μg per day and risedronate 35mg once per week was administered to the participants. The 26-week double-dummy treatment with vitamin D and calcium dosages was started among participants having BMD T-score ≤ –2.0 and ≥9.2 ng/mL 25 OHD. The 26-week treatment was succeeded by 52 weeks open-label treatment with same assigned active drugs. At 78 weeks of treatment, primary baseline endpoints were switched to lumbar spine (LS) BMD. Further, secondary and exploratory endpoints were changed in BMD on hip pain, proximal femur, proximal femur, radiological outcomes, quality of life and safety. The changes were measured with Timed up-and-go (TUG) & Visual Analog Scale (VAS). Moreover, the analysis of the data was calculated with mixed models for repeated measures (MMRM) and logistic regression.

A total 224 participants were randomized in the study, of which 171 patients (86 of teriparatide group) contributed toward efficacy analysis (mean ± SD age: 77 ± 7.7 years, 77% females). The BMD T-score results were evaluated for mean baseline LS, femoral neck (FN) and total hip (TH), were -2.16, -2.63 and -2.51, respectively. The BMD scores for LS and FN of teriparatide group increased significantly at 78 weeks [LS (+11.08% than +6.45%; p < 0.001); FN (+1.96% than –1.19%; p = 0.003)]. No change was seen in TH BMD values. The TUG test was lower in risedronate group as the comparison to teriparatide group in 6, 12, 18, and 26 weeks (–3.2 to –5.9 s; p = 0.045). Furthermore, reduced hip pain readings were noticed during the TUG test by 100 mm VAS with teriparatide group at 18 weeks (p = 0.033). The number of hip fracture was also lower in teriparatide group [two fractures] as compared to risedronate's group (seven fractures). Not only fracture count, but the levels of hypercalcemia and hyperuricemia were also frequent in risedronate group. During studies, the difference in secondary and exploratory outcomes was rarely seen.

Hence, it is concluded from overall studies that teriparatide shows better effect (great increase in LS & FN BMD, faster TUG test, less pain) as compared to risedronate in elder patients.

Source:

Journal of Bone and Mineral Research

Link to the source:

https://www.ncbi.nlm.nih.gov/pubmed/28019683

The original title of the article:

Effect of Teriparatide or Risedronate in Elderly Patients With a Recent Pertrochanteric Hip Fracture: Final Results of a 78-Week Randomized Clinical Trial

Authors:

Jorge malouf-sierra, umberta tarantino et al.

SearchTags: 
Therapeutic, Teriparatide, Risedronate, Fracture, Hip, Recombinant protein, Bisphosphonates, Randomized Clinical Trial, Efficacy, TUG, VAS
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