MON-802 - Comparable 6-month skeletal efficacy of once-weekly and daily teriparatide for primary prevention of glucocorticoid-induced osteoporosis: a randomized study

Title: Comparable 6-month skeletal efficacy of once-weekly and daily teriparatide for primary prevention of glucocorticoid-induced osteoporosis: a randomised study

Background: Glucocorticoid-induced osteoporosis (GIO) is characterized by rapid early bone loss following glucocorticoid initiation. The optimal strategy for primary prevention remains uncertain. We conducted a randomized controlled trial comparing daily teriparatide and once-weekly teriparatide for the prevention of early skeletal deterioration in newly glucocorticoid-exposed patients.

Methods: In this three-arm randomised trial, adults with idiopathic uveitis within ≤3 months of systemic glucocorticoid initiation were randomized to daily teriparatide (20 µg; n=20), once-weekly teriparatide (60 µg; n=20), or zoledronic acid (5 mg IV; n=20). Primary outcomes included percentage change in bone turnover markers (CTX, P1NP, ALP) and bone mineral density (BMD) at the lumbar spine (LS) and femoral neck (FN). Between-group comparisons were performed using ANOVA or Kruskal–Wallis tests, as appropriate.

Results: Baseline parameters were comparable across groups (all p>0.05). At 3 months, P1NP increased significantly in the anabolic arms (daily teriparatide: 88.3 ± 61.4 ng/mL; weekly teriparatide: 63.9 ± 24.8 ng/mL) compared with zoledronic acid (48.5 ± 18.3 ng/mL) (p < 0.01). At 6 months, mean lumbar spine BMD increased from 0.91 to 0.99 g/cm² in the daily teriparatide group and from 0.89 to 0.98 g/cm² in the weekly teriparatide group (8.8% vs 10.1%). Mean femoral neck BMD increased from 0.74 to 0.80 g/cm² with daily teriparatide and from 0.71 to 0.78 g/cm² with weekly teriparatide (8.1% vs 9.9%). No serious adverse events were observed.

Conclusions: Although bone formation markers were numerically higher with daily teriparatide, weekly teriparatide demonstrated comparable 6-month BMD improvements to daily teriparatide at both the lumbar spine and femoral neck.

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