Short-term anabolic agent and sequential therapy to improve bone mineral density and bone turnover markers in patients with osteoporotic hip fractures

Abstract

Background: Therapy using anabolic and antiresorptive agents in sequence is reportedly effective for severe osteoporosis management. However, evidence for this approach in osteoporotic hip fracture patients remains limited. This study aimed to evaluate the effectiveness of sequential therapy using short-term anabolic agents followed by antiresorptive treatment on bone mineral density (BMD) and bone turnover markers (BTMs) in patients with osteoporotic hip fractures.

Methods: We retrospectively reviewed 330 patients with osteoporotic hip fractures between February 2022 and December 2023 and selected 113 patients. The patients were categorized into a sequential group (n = 68), who received an anabolic agent (teriparatide or romosozumab) for three to six months, followed by two doses of denosumab administered at six-month intervals, and a non-sequential group (n = 45), who received anabolic agent monotherapy. The primary outcome was mean change in BMD at the lumbar spine (LS), femoral neck (FN), and total hip (TH) at one-year postoperatively. Secondary outcomes were the osteoporosis medication profile and mean change of 25-hydroxyvitamin D₃ (25(OH)D₃) and BTMs including C-terminal telopeptide (CTX) and procollagen type 1 N-terminal propeptide (P1NP).

Results: The sequential group showed significant increases in LS-, FN-, and TH-BMD at one-year follow-up (3.6 ± 3.7%, 4.4 ± 7.9%, and 1.9 ± 4.1%, respectively; p < 0.001 for all). In contrast, the non-sequential group showed non-significant changes in BMD at all sites. In the sequential group, CTX levels decreased significantly (0.57 ± 0.39 to 0.32 ± 0.30 ng/ml, p < 0.001), whereas the non-sequential group showed a non-significant increase in CTX levels (0.73 ± 0.47 to 0.90 ± 0.56 ng/ml, p = 0.44). P1NP levels decreased significantly in the sequential group (88.2 ± 65.7 to 66.2 ± 62.8 µg/L, p < 0.001). The 25(OH)D₃ levels improved in both groups but were higher in the sequential group (20.7 ± 11.1 to 37.2 ± 13.6 ng/mL).

Conclusion: Sequential therapy with short-term anabolic agents followed by antiresorptive therapy significantly improved BMD and normalized BTMs in patients with osteoporotic hip fractures. This treatment approach may be an effective strategy to enhance bone health and potentially reduce subsequent fracture risk in this high-risk population.