Calcified Tissue International

, Volume 104, Issue 2, pp 193–200 | Cite as

Reduction of Hip and Other Fractures in Patients Receiving Teriparatide in Real-World Clinical Practice: Integrated Analysis of Four Prospective Observational Studies

  • Stuart SilvermanEmail author
  • Bente L. Langdahl
  • Saeko Fujiwara
  • Ken Saag
  • Nicola Napoli
  • Satoshi Soen
  • Hiroyuki Enomoto
  • Thomas E. Melby
  • Damon P. Disch
  • Fernando Marin
  • John H. Krege
Original Research


The phase 3 teriparatide Fracture Prevention Trial showed significant reductions in vertebral (VF) and nonvertebral (NVF) fractures; however, patient exposure was insufficient for full analysis of low-incidence fractures, including hip. We assessed fracture results in pooled data from four prospective, observational teriparatide studies. Ambulatory women and men with osteoporosis received subcutaneous teriparatide 20 µg/day for up to 24 months per routine clinical practice. Fracture rates were compared between 6-month periods, using 0 to 6 months of treatment as the reference period. Analyses used a piecewise exponential model for first fracture. Hip, NVF, clinical VF (CVF), any clinical, and wrist fractures were assessed. For 8828 patients analyzed, mean age was 71 years; mean (SD) treatment duration was 17.4 (8.6) months. The rate of hip fracture decreased significantly for the > 12 to 18-month (− 47.7%) and > 18-month periods (-85.2%) versus the first 6 months of therapy, and for the > 18 versus the > 6 to 12-month period. NVF, CVF, and all clinical fractures were all significantly decreased in each post-reference period, with maximum decreases (> 18-month period) of 52.7%, 69.4%, and 61.2%, respectively, versus 0 to 6 months. No significant reduction was seen for rates of wrist fracture. Teriparatide treatment was associated with statistically significant decreases in hip fracture rate, particularly for > 18 months of treatment, and in NVF, CVF, and all clinical fracture rate in real-world patients. These results should be interpreted in the context of the non-controlled design of the source studies.


Fracture Anabolic Teriparatide Observational study 


Compliance with Ethical Standards

Conflict of interest

S.S. is on the Speaker’s Bureau and is a consultant for and has received research support from Eli Lilly and Co.; K.S. has received consultant fees and has research Grants from Eli Lilly and Co.; B.L.L. has received fees for serving on advisory boards, speaking at symposia, and has received research grants from Eli Lilly and Co. Amgen, UCB, Merck, and Novo Nordisk; NN has received consultant and speaker fees from Eli Lilly and Co.; S.F. and S.S. have nothing to declare; T.E.M. is an employee of Syneos Health under contract to Eli Lilly and Co.; D.P.D., F.M., H.E., and J.H.K. are employees of Eli Lilly and Co.

Ethical Approval

The studies analyzed herein were approved by local ethics committees or review boards, depending on local requirements, and were conducted in compliance with all applicable laws, regulations and guidelines.

Human and Animal Rights and Informed Consent

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Written informed consent was obtained from all individual patients included in the study.

Supplementary material

223_2018_485_MOESM1_ESM.docx (19 kb)
Supplementary material 1 (DOCX 19 KB)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Stuart Silverman
    • 1
    Email author
  • Bente L. Langdahl
    • 2
  • Saeko Fujiwara
    • 3
  • Ken Saag
    • 4
  • Nicola Napoli
    • 5
    • 11
  • Satoshi Soen
    • 6
  • Hiroyuki Enomoto
    • 7
  • Thomas E. Melby
    • 8
  • Damon P. Disch
    • 9
  • Fernando Marin
    • 10
  • John H. Krege
    • 9
  1. 1.Cedars-Sinai Medical Center, David Geffen School of Medicine, UCLA, and OMC Clinical Research CenterBeverly HillsUSA
  2. 2.Arhus University HospitalAarhusDenmark
  3. 3.Department of PharmacyYasuda Women’s UniversityHiroshimaJapan
  4. 4.University of Alabama at BirminghamBirminghamUSA
  5. 5.University Campus Bio-MedicoRomeItaly
  6. 6.Department of Orthopaedic Surgery and RheumatologyKindai University Nara HospitalIkomaJapan
  7. 7.Eli Lilly Japan K.K.KobeJapan
  8. 8.Syneos HealthRaleighUSA
  9. 9.Eli Lilly and CompanyIndianapolisUSA
  10. 10.Lilly Research CentreWindleshamUK
  11. 11.Istituto Ortopedico GaleazziMilanItaly

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