Michael Monostra , 2025-04-24 12:48:00
April 24, 2025
3 min read
Key takeaways:
- Researchers determined baseline BMD T-score cutoffs for achieving a T-score of higher than –2.5 with abaloparatide and teriparatide.
- Anabolic therapies may be better for adults needing a larger BMD increase.
Health care professionals should assess baseline bone mineral density in patients with osteoporosis before determining first-line therapy, researchers report.
As Healio previously reported from an analysis of the FREEDOM trial, women with osteoporosis had a 50% or greater chance of reaching their target BMD at 3 years with denosumab (Prolia, Amgen) if they had a BMD T-score of –2.8 or higher at the total hip or –3.1 or higher at the lumbar spine at baseline. New findings published in the Journal of Bone and Mineral Research similarly examined the probability of reaching a BMD target, this time for women with osteoporosis using abaloparatide (Tymlos, Radius Health) or teriparatide.
“These data are important because they provide the likelihood of achieving treatment targets in patients with different medications and medication sequences,” Felicia Cosman, MD, professor of medicine at Columbia University Vagelos College of Physicians and Surgeons, told Healio. “Health care professionals need this information to help make decisions about who should receive anabolic treatments like abaloparatide as initial therapy.”
Cosman and colleagues conducted a post hoc analysis of the ACTIVE trial, in which 2,463 women aged 49 to 86 years with osteoporosis were randomly assigned to once-daily abaloparatide, teriparatide or placebo for 18 months. Data were also obtained from the ACTIVExtend trial, in which participants in the abaloparatide and placebo groups of ACTIVE received once-weekly alendronate for 2 years. Researchers calculated the probability women with a BMD T-score of –2.5 or lower at baseline would achieve a BMD T-score of higher than –2.5 at the total hip or lumbar spine.
At 1 year in ACTIVE, participants had a 50% or greater chance of achieving a BMD T-score of higher than –2.5 at the total hip if they had a baseline T-score as low as –2.7 with abaloparatide and –2.6 with teriparatide. At the lumbar spine, a 50% or greater chance of reaching a BMD T-score of greater than –2.5 was seen with a baseline T-score as low as –3.2 with abaloparatide or –3 with teriparatide.
At 18 months, women had more than 50% chance of reaching a total hip BMD T-score of more than –2.5 with a baseline T-score as low as –2.7 with abaloparatide and teriparatide. A 50% or greater probability of reaching a BMD T-score of higher than –2.5 at the lumbar spine was observed for those with a baseline T-score as low as –3.3 with abaloparatide and –3.2 with teriparatide.
Among women who received alendronate in the ACTIVExtend trial, a 50% or greater likelihood for achieving a total hip BMD T-score of more than –2.5 was seen with a baseline T-score as low as –2.9 for women who received abaloparatide in the original trial and as low as –2.7 for those in the placebo group in the original trial. Women had 50% or higher odds for reaching a lumbar spine BMD T-score of higher than –2.5 if they had a baseline BMD T-score as low as –3.5 with abaloparatide in the ACTIVE trial or –3 with placebo in the original trial.
Cosman said the findings from ACTIVExtend are particularly important as the order patients receive treatments can influence response.
“In people who need a bigger BMD boost, anabolic agents should be given as initial treatment because BMD gains are larger compared with transitioning from a bisphosphonate or denosumab to anabolic medication,” Cosman said.
The researchers concluded that health care professionals need to factor in baseline BMD and a person’s probability for achieving their BMD T-score goal when considering which osteoporosis treatment to initiate.
For more information:
Felicia Cosman, MD, can be reached at felcosman@gmail.com.
Sources/Disclosures
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Disclosures:
Cosman reports receiving research support from Radius Health, consulting for Amgen, Biocon, Curateq, EnteraBio, Radius Health, Sumitomo and UCB, speaking for Amgen and Radius Health, and advising for Amgen, Enterabio and UCB. Please see the study for all other authors’ relevant financial disclosures.
