Sequential use of teriparatide and risedronate in multifractured severe osteoporosis : Clinical results at 30 month F.U

The efficacy of teriparatide in multifractured severe osteoporosis to reduce significantly the rate of complications and the relative risk of new fracture has been recognized. Recently the prolonging of beneficits with sequential use of bysphosphonates has been debated. The purpose of the present study was to evaluate compliance and persistence with treatment and relative risk of new fracture of severe osteoporotic patients who are managed with teriparatide and risedronate in sequence. Methods: 42 compliant female between 57 and 96 years-old presenting a femoral and/or vertebral fracture were recruited. During hospitalization they were undergone to a routinary instrumental examins completed by biochemical bone turnover markers and BMD by DXA. From day 7 by recovery they received daily subcutaneous teriparatide (20 microg) per day for 18 months and risedronate 35mg weekly for other 12months. 800mg of calcium and 400 UI of vitamin D daily as oral supplementation. All the patients repeated: xrays of affected segments at 2, 4months; biochemical bonemarkers 1, 3, 6,12,18, 24, 30months;DEXA at first, second, third year. The evaluation of the quality of life was evaluated with EQ-5 in terms of recovery of walking, with a questionnaire. Results: 2/3 of patients was afflicted by a proximal femoral fracture treated surgically associated to a previous vertebral compression fracture. Other fourteen suffered for multiple vertebral fractures treated with brace. The healing was detected with radiograms. The vitamin D was at lower levels at admission but the supplementation was sufficient to normalize. The other biochemical variables of bone formation and resorption peaked within the consolidation process. At six month they were indistinguishable from baseline and mantained for three years. Lumbar and contralateral femoral BMD were increased after 12 months and maintained in two yaers. At thirty month follow-up , the rate of survaillance was 100%, persistence was 95.3% because of discontinuation of 2 patients in the first two months for epigastralgy. The quality of life and functional outcome were improved significantly and maintained. Conclusions: In multifractured severe osteoporosis sequential treatment with teriparatide and risedronate can improve the healing process at the beginning and reduce the rate of new fragility fractures in the first 30 months with re-balancing of bone turnover markers.