Teriparatide vs. Risedronate in reducing the pain and time of TUG test

A randomized, active-controlled, double-blind clinical trial of 78 weeks by Malouf-Sierra J et al compared teriparatide with risedronate in elderly patients with a recent pertrochanteric hip fracture.

The study randomized 224 patients, and 171 (86 teriparatide, 85 risedronate) were included in the analysis. Teriparatide 20 µg (once daily) and risedronate 35 mg (once weekly) was administered starting within 2 weeks after fixation of a low-trauma pertrochanteric hip fracture. The primary inclusion criteria included a bone mineral density T-score of £-22.0 and 25OHD>9.2 ng/mL. During the first 26 weeks, patients were given active drugs involved in the study along with calcium and vitamin D in a double-blinded fashion.

The primary endpoint of the study was changed from baseline in lumbar spine (LS) BMD at 78 weeks. Secondary and exploratory endpoints included change in BMD at the proximal femur, function, hip pain (Charnley score and 100 mm Visual Analog Scale [VAS]), quality of life (short form−36), radiology outcomes, and safety. The mean age was 77 [7.7] years, 77% were female, and mean baseline LS, femoral neck (FN), and total hip (TH) T-scores were −2.16, −2.63, and −2.51, respectively.

Visual analog scale (VAS)-assessed hip pain during the TUG test was reduced with teriparatide as compared to risedronate. Patients displayed lesser pain on a VAS instantly after timed up-and-go (TUG) test was significantly faster with teriparatide at 6, 12, 18, and 26 weeks (differences: −3.2 to −5.9 seconds; p = 0.045 for overall difference). At 78 weeks, BMD increased significantly with teriparatide compared to risedronate at the lumbar spine (+11.08% vs +6.45%; p < 0.001) and FN (+1.96% vs −1.19%; p = 0.003), with no significant group difference in TH BMD. There were 2 new fractures in the teriparatide group and 7 in the risedronate group. Hyperuricemia and hypercalcemia were more frequent with teriparatide group.

Teriparatide was associated with less pain and a shorter time to complete the TUG test as compared to risedronate. Other fracture-recovery outcomes were not significantly different between the two groups.