A recent study compared the effectiveness against fractures of 2 drugs in women with severe osteoporosis.
No clinical trial has compared osteoporosis drugs with fractures as the primary endpoint. In this good quality trial (double blind and double placebo), the women selected are postmenopausal with at least two moderate or severe vertebral fractures and a T score in bone densitometry less than or equal to -1.50.
A 24-month controlled study
They were drawn at random to receive either 20 μg of teriparatide as a subcutaneous injection once a day (plus an oral placebo) for the first group. In the second group, they received 35 mg of risedronate orally once a week (plus daily injections of placebo).
The primary endpoint was new radiographic vertebral fractures. Secondary endpoints included new and worsening radiographic vertebral fractures, clinical fractures, and non-vertebral fractures. The study lasted for 24 months and is published in the Lancet.
Less risk with teriparatide
A total of 680 women were recruited from each group. At the end of the study, at 24 months, new vertebral fractures were observed in 28 (5.4%) of the 680 women in the teriparatide group and 64 (12%) of the 680 women in the risedronate group. Regarding clinical fractures, there were 30 (4.8%) in the teriparatide group versus 61 (9.8%) in the risedronate group. Finally, fragility fractures other than vertebral fractures were observed in 25 (4%) women in the teriparatide group and 38 (6.1%) in the risedronate group.
Clearly, for postmenopausal women with severe osteoporosis, the risk of new vertebral fractures, radiological and clinical, is significantly lower with teriparatide, which is a molecule that stimulates osteoblasts (the cells that make bone) compared to risedronate, which is a drug that slows down osteoclasts (the cells that renew bone).
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