Efficacy of Switching From Teriparatide to Bisphosphonate or Denosumab: A Prospective, Randomized, Open-Label Trial

There is no consensus onan optimal treatment after daily teriparatide (TPTD). We performed a prospective, randomized, open-label, 12-month trial to investigate the efficacy of follow-up treatment after daily TPTD treatment for Japanese patients. Three-hundred patients were enrolled in this study. Patients received oral bisphosphonate (BP) including alendronate (ALN; 35mg/week) and minodoronate (MINO; 50mg/month), or subcutaneous denosumab (60mg/6 month). The primary efficacy measure was bonemineral density (BMD) responses in the lumbar spine (LS) and femoral neck (FN). Lumbar spine BMD increased by 1.3 perpendicular to 5.1% in the ALN subgroups, 0.5 perpendicular to 4.6% in the MINO subgroups, and 4.3 perpendicular to 3.5% in the denosumab subgroups. Femoral neck BMD increased by 0.7 perpendicular to 4.6% in the ALN subgroups, 0.2 perpendicular to 4.6% in the MINO subgroups, and 1.4 perpendicular to 3.4% in the denosumab subgroups. Lumbar spine BMD increases were significantly greater in the denosumab subgroup than the BP subgroups. There were no significant differences in FN BMD increases among the three subgroups. Lumbar spine BMD increases were significantly greater in the denosumab subgroup than the BP subgroups, whereas FN BMD increases were not significant. Denosumab treatment was more effective in increasing BMD and therefore has the potential benefit of fracture prevention. Further research is warranted to determine the optimal treatment after daily TPTD. (C) 2018 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.