In postmenopausal women, 2-years of combined teriparatide and denosumab increases bone mineral density (BMD) more than either drug alone and switching from either combination or teriparatide to denosumab for an additional 2-years further increases BMD. Conversely switching from denosumab to teriparatide results in transient bone loss. The effects of these interventions on spine microarchitecture are unknown. In the DATA and DATA-Switch studies, 94 postmenopausal osteoporotic women were randomized to receive 24-months of teriparatide (20-μg-daily), denosumab (60-mg-every-6-months), or both. Then, women originally assigned to 24-months of teriparatide received 24-months of denosumab whereas subjects originally randomized to 24-months of denosumab received 24-months of teriparatide. Subjects who received both drugs received an additional 24-months of denosumab alone. Spine trabecular bone score (TBS, a gray-level textural assessment of bone microarchitecture) was measured blinded from treatment groups using images from 2-dimensional DXA spine scans at 0, 12, 24, 30, 36, and 48 months in 65 women who had PA spine DXA images suitable for TBS analysis. After 24 months, TBS increased by 2.7±4.7% in the teriparatide group (P=0.009 versus baseline), by 1.8±5.0% in the denosumab group (P=0.118 versus baseline), and by 4.5±6.7% in the combination group (P=0.017 versus baseline), with no significant between-group differences. In the 6-months after treatments were switched (months 24–30), TBS continued to increase in the combination-to-denosumab and teriparatide-to-denosumab groups but decreased by −1.1±4.0% in the denosumab-to-teriparatide group (P<0.05 versus other groups). After 48 months, compared to month 0, TBS increased by 5.1±5.8% in the teriparatide-to-denosumab group, by 3.6±4.2% in the denosumab-to-teriparatide group, and by 6.1±4.7% in the combination-to-denosumab group (P<0.001 versus baseline for all groups, P=NS for between group differences). Switching from teriparatide-to-denosumab also increases spine TBS. Conversely, switching from denosumab-to-teriparatide transiently degraded spine trabecular microarchitecture, the clinical consequences of which require further study.
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