Testing Osteoporosis Treatments in a Clinical Setting

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Osteoporosis, a condition of reduced bone density that results in weakened, fragile bones making them more likely to break, affects over 3 million people in the UK.  It is responsible for over half a million people a year having to seek hospital treatment for fragility fractures associated with their osteoporosis.

Teriparatide (TPTD) is the most widely used bone building medicine in the treatment of patients with osteoporosis, however its use is restricted in many countries. In the UK the drug is only available to certain patient groups, with its use in Scotland being predominantly by specialists treating severe osteoporosis in postmenopausal women.

Following on from a recent randomised study (Kendler, D.L et al, The Lancet 2018) that showed that TPTD was better than a commonly used treatment risedronate at preventing spine fractures over a 2-year period, a research group from the Centre for Genomic and Experimental Medicine led by Dr Philip Riches, sought to test whether this benefit is also seen in real life practice. 

In work published in the journal Calcified Tissue International, the research team report the results of an extended observational study of 724 women referred to a specialist clinic with severe osteoporosis over an 11.5-year period who were considered for TPTD therapy. Of these patients, 496 were treated with TPTD while the remaining 228 received other treatments. Results of the study showed that those treated with TPTD had a greater increase in bone density in the spine compared with standard care after 2 years and had fewer fractures in the spine. Though there was no difference between groups with respect to either bone density changes in the hip or the number of fractures not affecting the spine. This study confirms that TPTD is superior to standard care at reducing the risk of spine fracture in patients with severe osteoporosis.

One of the strengths of this study is that it provides information regarding the use of TPTD in real-world, clinical practice. This study is unique as it includes elderly patients with multiple co-morbidities, few of whom would be likely to meet the criteria allowing them to be included in controlled trials. It helps with the interpretation of how findings from randomised controlled trials translate into routine clinical practice.

Dr Philip Riches

links

Dr Philip Riches Research Webpage

Read the publication in Calcified Tissue International https://doi.org/10.1007/s00223-019-00563-8