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

We present final results of a study comparing teriparatide 20\u2009\u3bcg every day (QD) with risedronate 35\u2009mg once per week (QW) started within 2 weeks after surgery for a pertrochanteric hip fracture. Patients with BMD T-score\u2009 64\u2009-2.0 and 25OHD 659.2\u2009ng/mL were randomized to receive 26-week double-dummy treatment plus calcium and vitamin D, followed by 52-week open-label treatment with the same assigned active drug. Primary endpoint was change from baseline in lumbar spine (LS) BMD at 78 weeks. Secondary and exploratory endpoints were change in BMD at the proximal femur, function, hip pain (Charnley score and 100\u2009mm Visual Analog Scale [VAS]), quality of life (Short Form-36), radiology outcomes, and safety. Data were analyzed with mixed models for repeated measures (MMRM) and logistic regression. Totally, 224 patients were randomized; 171 (teriparatide: 86) contributed to the efficacy analyses (mean\u2009\ub1\u2009SD age: 77\u2009\ub1\u20097.7 years, 77% females). Mean baseline LS, femoral neck (FN), and total hip (TH) T-scores were -2.16, -2.63, and -2.51, respectively. At 78 weeks, BMD increased significantly more with teriparatide compared to risedronate at the LS (+11.08% versus +6.45%; p\u2009<\u20090.001) and FN (+1.96% versus -1.19%; p\u2009=\u20090.003), with no significant between-group difference in TH BMD. Timed up-and-go (TUG) test was significantly faster with teriparatide at 6, 12, 18, and 26 weeks (differences: -3.2 to -5.9\u2009s; p\u2009=\u20090.045 for overall difference). Hip pain during TUG test by 100\u2009mm VAS was significantly lower with teriparatide at 18 weeks (adjusted difference: -11.3\u2009mm, p\u2009=\u20090.033; -10.0 and -9.3\u2009mm at 12 and 26 weeks, respectively; p\u2009=\u20090.079 for overall difference). Other secondary and exploratory outcomes were not different. Teriparatide group showed two new hip fractures versus seven with risedronate (p\u2009=\u20090.171) and more frequent hypercalcemia and hyperuricemia. In conclusion, 78-week treatment with teriparatide showed significantly greater increases in LS and FN BMD, less pain, and a faster TUG test versus risedronate. \ua9 2016 American Society for Bone and Mineral Research