Teriparatide seems to improve recovery after pertrochanteric hip fracture : Comparison with risedronate in a randomized, controlled trial

To compare the effects on fracture recovery of 26 wks' therapy with an oral antiresorptive (risedronate: RIS 35 mg QW) or a bone forming drug (teriparatide: TPTD 20 ug QD) started within 2 wks after osteosynthesis in a pertrochanteric hip fracture in patients with low bone mass. Methods: 224 patients were randomized to study drug and an oral/injectable placebo plus calcium/vitD3 in an osteoporosis trial. The primary outcome was bone mineral density which will be reported elsewhere. We report secondary (Timed Up-and-Go [TUG] test, hip pain, SF-36, safety) and exploratory (radiography) endpoints. Efficacy analyses of the TUG test, patient-rated health status, and hip pain 100 mm Visual Analog Scale were performed with a Mixed-effects Model for Repeated Measures. Results: Mean age was 77 years and 77% were female. The teriparatide group completed the TUG test in a shorter time (LS means 5.7, 4.4, 3.1, and 3.1 seconds less at 6, 12, 18, and 24 wks; overall difference p = 0.021) and reported less hip pain during the test (LS means 8.7, 10.6, 11.9, and 10.2 mm differences at 6, 12, 18, and 26 wks; overall difference p = 0.032). No significant between-group differences in SF-36, Charnley hip pain score, ability to walk or walking aids during follow-up. No patient was radiographically healed at 6 wks, and 90% were healed at 12 wks in both groups. Implant failure (TPTD:7, RIS:8), loss of reduction (TPTD:2, RIS:4) or non-union (0 cases) showed no significant differences. Mild hypercalcemia and hyperuricemia were more frequent with teriparatide. Conclusions: Patients treated with teriparatide reported less hip pain and shorter time to complete the TUG test than RIS between 6-26 wks. These outcomes were secondary.