Osteologie 2019; 28(01): 70
DOI: 10.1055/s-0039-1680033
Posterbegehung 2
Georg Thieme Verlag KG Stuttgart · New York

Pro-Remodeling Effect of Teriparatide Therapy is Associated with Loss of Cortical Mass at the Hip in the STRUCTURE Study

B Langdahl
1   Aarhus University Hospital, Aarhus
,
D Kendler
2   University of British Columbia, Department of Medicine, Vancouver, BC
,
E Jódar Gimeno
3   Hospital Universitario Quirón Salud, Servicio de Endocrinología, Madrid
,
L Hyldstrup
4   Hvidovre University Hospital, Hvidovre
,
E Dokoupilova
5   Medical Plus, Uherske Hradiste
,
P Lakatos
6   Semmelweis University, Department of Medicine, Budapest
,
M Bolognese
7   Bethesda Health Research Center, Bethesda, MD
,
L Chen
8   Amgen Inc., Thousand Oaks, CA
,
D Barry Crittenden
8   Amgen Inc., Thousand Oaks, CA
,
L Möckel
9   UCB Pharma, Monheim
,
C Libanati
10   UCB Pharma, Brussels
› Author Affiliations
Further Information

Publication History

Publication Date:
05 March 2019 (online)

 

Introduction:

Romosozumab, a sclerostin monoclonal antibody, increases bone formation and decreases bone resorption, while teriparatide increases both formation and resorption. STRUCTURE (NCT01796301) reported greater gains in bone mineral density (BMD) at spine and hip with romosozumab versus teriparatide. Using quantitative computed tomography (QCT), hip cortical BMD and content (BMC) declined with teriparatide (1), which may result from increased bone resorption.

Methods:

436 women with postmenopausal osteoporosis transitioning from oral bisphosphonates received subcutaneous romosozumab 210 mg once monthly or teriparatide 20 µg once daily for 12 months (m). Cortical BMD and BMC were assessed by QCT at the hip. Serum procollagen type 1 N-telopeptide (P1NP) and type 1 collagen C-telopeptide (CTX) were measured at intervals up to 12 m. The association between area under the curve (AUC) of the change in bone turnover markers and cortical hip BMD/BMC was assessed.

Results:

Mean baseline BMD T-score was -2.24 (total hip), -2.85 (lumbar spine); 90.4% received alendronate (mean 5.6 years) before screening. At 12 m, hip cortical BMD and BMC increased from baseline by 1.1% and 2.9% in the romosozumab group and decreased with teriparatide (-3.6% and -1.3%, respectively; p < 0.0001, romosozumab vs. teriparatide). With romosozumab, CTX decreased, returning to and remaining at baseline after 3 m. With teriparatide, CTX increased and remained above baseline for 12 m; hip cortical BMD/BMC decrease correlated with CTX AUC increase (r =-0.47 and -0.38 respectively, p < 0.0001).

Discussion:

The bone resorption increase following teriparatide correlated with the reduction in hip cortical BMD/BMC, suggesting that the pro-remodeling action of teriparatide can have a negative effect on cortical bone over 12 months. As romosozumab increases bone formation while decreasing bone resorption with rapid gains in hip cortical BMD/BMC, it may offer therapeutic advantages for patients at high risk of hip fracture. *LM: Presenting on behalf of the authorship group. Reference: 1. Langdahl et al, EULAR 2016