Endocrine Abstracts

JOINT2945

The beneficial effect of antiresorptive treatment following anabolic treatment on bone fragility is well known, but there are no real-life data on the risk change in the absence of such treatment. In our retrospective longitudinal study, we examined the fracture data of patients receiving teriparatide therapy in Hungary between 1 January 2009 and 31 December 2023 using the databases of the National Health Insurance Fund Administration. There is a single health insurance fund in Hungary, so both prescription and fracture data are considered representative of the total population. We investigated the trend in hip fracture rates during and after teriparatide treatment as a function of adherence, depending on whether patients received sequential antiresorptive treatment. 13 774 patients with severe osteoporosis were treated with teriparatide during the study period. Of these, data were analysed for 8893 patients who had completed teriparatide treatment by the end of 2021 and had an adherence rate to teriparatide treatment of more than 20%. 91% of patients were female and 8. 7% of patients had a hip fracture during the entire observation period. Within 90 days of teriparatide treatment, 20% of patients received denosumab and 10% received a bisphosphonate. Even without sequential treatment three years after teriparatide treatment, the number of hip fractures was significantly lower in the group with more than 80% adherence than in the group with less than 20% adherence (P < 0. 01). However, treatment with denosumab or a bisphosphonate after teriparatide discontinuation significantly reduced the risk of hip fracture compared with those who did not receive an antiresorptive agent. (RR: 0. 469, P < 0. 01) The timing of treatment initiation also influenced the increase in fracture risk. If treatment was continued beyond 90 days, the relative risk increased significantly, with this delay almost doubling the risk of hip fracture if treatment was continued with denosumab (RR: 1. 48, P < 0. 01). In conclusion, although the beneficial effect of teriparatide treatment can be demonstrated for years without continued treatment, antiresorptive treatment started within 90 days can achieve an additional fracture risk reduction of more than 50%. Our study provides fracture data to support a clear benefit of sequential therapy after teriparatide treatment.