Forearm bone mineral density and fracture incidence in postmenopausal women with osteoporosis: results from the ACTIVExt
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ORIGINAL ARTICLE
Forearm bone mineral density and fracture incidence in postmenopausal women with osteoporosis: results from the ACTIVExtend phase 3 trial N.B. Watts 1 & R.K. Dore 2 M.S. LeBoff 6
&
S. Baim 3
&
B. Mitlak 4
&
G. Hattersley 4
&
Y. Wang 4
&
T.D. Rozental 5
&
Received: 31 January 2020 / Accepted: 17 July 2020 # The Author(s) 2020
Abstract Summary Abaloparatide increased ultradistal radius bone mineral density (BMD) in the Abaloparatide Comparator Trial in Vertebral Endpoints (ACTIVE) trial. Over the subsequent 24 months in ACTIVExtend, ultradistal radius BMD gains were maintained with alendronate. Conversely, 1/3 radius BMD remained stable during ALN treatment in ACTIVExtend after decreasing during ACTIVE. Introduction Abaloparatide (ABL) increased femoral neck, total hip, and lumbar spine bone mineral density (BMD) in postmenopausal women with osteoporosis and decreased the risk of vertebral and nonvertebral fractures in ACTIVE. Effects on fracture risk and BMD were maintained subsequently with alendronate (ALN) in ACTIVExtend. In a prespecified subanalysis of ACTIVE, ABL also increased BMD at the ultradistal radius. Our objective was to determine the efficacy of ABL followed by ALN vs placebo (PBO) followed by ALN on forearm BMD and fracture risk over 43 months in ACTIVExtend. Methods Ultradistal and 1/3 radius BMD (ACTIVE baseline to month 43) were measured (ABL/ALN, n = 213; PBO/ALN, n = 233). Wrist fracture rates were estimated for the ACTIVExtend intent-to-treat population (ABL/ALN, n = 558; PBO/ALN, n = 581) by Kaplan-Meier (KM) method. Results At cumulative month 25, mean increase from ACTIVE baseline in ultradistal radius BMD was 1.1% (standard error, 0.49%) with ABL/ALN vs − 0.8% (0.43%) with PBO/ALN (P < 0.01). BMD increases with ABL were maintained with ALN through month 43 in ACTIVExtend. BMD decreases at the 1/3 radius in ACTIVE (similar with ABL and PBO) were maintained through 24 months of ALN treatment in ACTIVExtend. Wrist fractures over 43 months occurred in 15 women with ABL/ALN (KM estimate, 2.8%) and 20 with PBO/ALN (KM estimate, 3.6%) (HR = 0.77, 95% CI 0.39, 1.50; P = not significant). Conclusion Ultradistal radius BMD gains following treatment with ABL in ACTIVE were maintained over 24 months of ALN treatment in ACTIVExtend. Conversely, 1/3 radius BMD remained stable during ALN treatment in ACTIVExtend after decreasing during ACTIVE. Trial registration ClinicalTrials.gov: NCT01657162 submitted July 31, 2012 Keywords Abaloparatide . Alendronate . Wrist fracture . Bone mineral density . Osteoporosis
* B. Mitlak [email protected] 1
Mercy Health Osteoporosis and Bone Health Services, Cincinnati, OH, USA
2
Robin K. Dore, MD, Inc., Tustin, CA, USA
3
Rush University Medical Center, Chicago, IL, USA
4
Radius Health, Inc., 950 Winter Street, Waltham, MA 02451, USA
5
Beth Israel Deaconess Medical Center, Boston, MA, USA
6
Brigham and Women’s Hospital, Boston, MA, USA
Introduction Wrist fractures are the most common fracture of the upper extremity, and frac
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