MON-828 - Sequential Zoledronate Versus Denosumab after Teriparatide in Diabetic and Non-Diabetic Postmenopausal Women with Osteoporosis: A Registry-Based Analysis

Background
Sequential antiresorptive therapy following teriparatide is essential to preserve anabolic gains in bone mineral density (BMD). Diabetes mellitus (DM) is associated with altered bone quality and fracture risk, yet its influence on skeletal response to sequential osteoporosis therapy remains poorly defined, particularly in Indian populations.
Objective
To compare BMD outcomes after sequential therapy with zoledronate or denosumab following teriparatide in postmenopausal women with osteoporosis, stratified by diabetes status.
Methods
In this registry-based observational analysis from a tertiary care centre, 48 postmenopausal women with osteoporosis (DM, n=18; non-DM, n=30) who completed 24 months of teriparatide were included. Patients subsequently received either zoledronate (n=19) or denosumab (n=29). BMD at the lumbar spine (LS), femoral neck (FN), and total hip (TH) was assessed at baseline, after teriparatide, and following sequential therapy. BMD outcomes were compared between diabetic and non-diabetic patients within each treatment arm.
Results
Teriparatide therapy resulted in significant BMD increases at all skeletal sites across the cohort, irrespective of diabetes status. Following sequential therapy, patients receiving teriparatide plus zoledronate demonstrated comparable BMD outcomes between diabetic and non-diabetic groups at LS, FN, and TH. In contrast, among patients receiving teriparatide followed by denosumab, those with diabetes exhibited significantly greater BMD gains at cortical-rich skeletal sites, including the femoral neck (0.684 vs 0.591 g/cm², p=0.032) and total hip (0.801 vs 0.701 g/cm², p=0.039), compared with non-diabetic patients. Lumbar spine BMD responses were similar between groups.
Conclusion
Both zoledronate and denosumab effectively preserved teriparatide-induced BMD gains. However, denosumab conferred superior femoral neck and total hip benefits in postmenopausal women with diabetes, suggesting that diabetes may modulate skeletal responsiveness to sequential antiresorptive therapy. Denosumab may represent a preferred sequential option after teriparatide in patients with osteoporosis and concomitant diabetes.

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