Abaloparatide effect on forearm bone mineral density and wrist fracture risk in postmenopausal women with osteoporosis
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ORIGINAL ARTICLE
Abaloparatide effect on forearm bone mineral density and wrist fracture risk in postmenopausal women with osteoporosis N.B. Watts 1 & G. Hattersley 2 & L.A. Fitzpatrick 2 & Y. Wang 2 & G.C. Williams 2 & P.D. Miller 3 & F. Cosman 4 Received: 28 September 2018 / Accepted: 31 January 2019 # The Author(s) 2019
Abstract Purpose Wrist fractures are common, contribute significantly to morbidity in women with postmenopausal osteoporosis, and occur predominantly at the ultradistal radius, a site rich in trabecular bone. This exploratory analysis of the phase 3 ACTIVE study evaluated effects of abaloparatide versus placebo and teriparatide on forearm bone mineral density (BMD) and risk of wrist fracture. Methods Forearm BMD was measured by dual energy X-ray absorptiometry in a subset of 982 women from ACTIVE, evenly distributed across the three treatment groups. Wrist fractures were ascertained in the total cohort (N = 2463). Results After 18 months, ultradistal radius BMD changes from baseline were 2.25 percentage points greater for abaloparatide compared with placebo (95% confidence interval (CI) 1.38, 3.12, p < 0.001) and 1.54 percentage points greater for abaloparatide compared with teriparatide (95% CI 0.64, 2.45, p < 0.001). At 18 months, 1/3 radius BMD losses (versus baseline) were similar for abaloparatide compared with placebo (−0.42; 95% CI −1.03, 0.20; p = 0.19) but losses with teriparatide exceeded those of placebo (−1.66%; 95% CI −2.27, −1.06; p < 0.001). The decline with abaloparatide was less than that seen with teriparatide (group difference 1.22%; 95% CI 0.57, 1.87; p < 0.001). The radius BMD findings, at both ultradistal and 1/3 sites, are consistent with the numerically lower incidence of wrist fractures observed in women treated with abaloparatide compared with teriparatide (HR = 0.43; 95% CI 0.18, 1.03; p = 0.052) and placebo (HR = 0.49, 95% CI 0.20, 1.19, p = 0.11). Conclusions Compared with teriparatide, abaloparatide increased BMD at the ultradistal radius (primarily trabecular bone) and decreased BMD to a lesser extent at the 1/3 radius (primarily cortical bone), likely contributing to the numerically lower wrist fracture incidence observed with abaloparatide. Keywords Abaloparatide . Bone mineral density . Osteoporosis . Teriparatide . Wrist fracture
Introduction Radius Health, Inc., performed the work related to this study. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00198-019-04890-2) contains supplementary material, which is available to authorized users. * N.B. Watts [email protected] 1
Mercy Health Osteoporosis and Bone Health Services, Cincinnati, OH, USA
2
Radius Health, Inc., Waltham, MA, USA
3
Colorado Center for Bone Research, Lakewood, CO, USA
4
Columbia University College of Physicians and Surgeons, New York, NY, USA
Osteoporotic fractures place a large burden on patients and a major economic toll on society [1]. Fractures of the distal radius are the most common upper extremity fracture in older adults
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