P112 Teriparatide versus anti-resorptive treatment in rheumatoid arthritis patients with severe osteoporosis: an observational study
Authors: Hauser Barbara , Berg Kathryn M , Lambert Justine A , Ralston Stuart H 
Published: April 2021

Background/Aims 

Patients with rheumatoid arthritis (RA) are at increased risk of developing osteoporosis (OP) and have a twofold increased risk of vertebral fracture compared with the general population. There is increasing evidence that teriparatide (TPTD) is superior to anti-resorptive medication in patients with severe spinal OP.The aim of this study was to compare the efficacy of TPTD with anti-resorptive treatment (ART) in RA patients with severe spinal OP.

Methods 

Observational study of RA patients and controls with severe OP who were referred to a specialist osteoporosis clinic. Patients with a history of two vertebral fractures or a spinal BMD Tscore &lt; -4 were offered either TPTD or standard care with either oral or parenteral ART. After completion of TPTD treatment patients were advised to commence ART. DEXA re-evaluation was usually performed after 1, 2 and 5 years.

Results 

We studied 59 postmenopausal women with RA who had severe spinal OP. In the RA group 29 patients received TPTD treatment and 30 patients were started on ART (12 Zoledronic acid, 11 Alendronate, 3 Risedronate, 2 Denosumab, 1 Etidronate and 1 unknown).RA patients who were started on TPTD were on average 5 years younger (65.4 ±10.6) than patients who were started on ART (70.6±8.2; p = 0.041). Slightly more than half of TPTD RA patients (55.2%) had previously received bisphosphonates and 10.3% received low dose Prednisolone (mean± SD dose = 5.5 ± 3.3 mg). Baseline lumbar spine T-score was -4.25±0.57 in the RA TPTD group. Patients with RA who elected to have ART as opposed to TPTD had higher BMD values as compared with those who chose to have TPTD (T-score = -3.39±1.09; p = 0.001, from RA TPTD group).We found that increase in BMD with TPTD treatment was superior to ART in the RA group at increasing spine BMD after 2 years (+17.59% ± 9.63% vs 3.19 % ± 4.99% , p value&lt;0.001). Assessment after 5 years following commencement of ART showed that spine BMD remained higher in the RA TPTD group than in the RA ART group alone (18.0% ± 11.6% vs 6.36 % ± 8.95%; p = 0.019). However, there was no significant difference between TPTD and ART on hip BMD change at 2 years (+ 3.6% ± 12.2 % vs -0.57% ± 5.96%, p = 0.237) or 5 years (+1.0% ± 10.9% vs -0.3% vs ± 7.8%, p = 0.724).

Conclusion 

This real-world study confirms that TPTD treatment is more effective in treating severe spinal OP in RA patients than antiresorptive medication alone. Despite the fact that the majority of RA patients had been pre-treated with bisphosphonates the TPTD treatment effect in RA patients was robust. Anabolic treatment with TPTD is a good option for RA patients with severe spinal OP.

Disclosure 

B. Hauser: Other; Dr Hauser has received fees for a promotional article from Gedeon Richter. K.M. Berg: None. J.A. Lambert: None. S.H. Ralston: Grants/research support; Prof Ralston has received grant funding from Lilly for an observational study and donation of Teriparatide for the TOPAZ trial in Osteogenesis Imperfecta.