OA34 Real-world use of teriparatide in osteoporosis management

Abstract Background/Aims Teriparatide, a recombinant human parathyroid hormone, significantly reduces the risk of fractures in patients with postmenopausal and glucocorticoid-induced osteoporosis. In the UK, NICE has restricted its use to high-risk patient groups. This project aims to analyse the use of teriparatide at a large university teaching hospital with 55% ethnic catchment population, providing insight into the real-world patient demographic and evaluating the treatment’s effectiveness. Methods A retrospective analysis was conducted to evaluate the use of teriparatide in patients receiving treatment between 2014 and 2024 at our unit. Full demographic and clinical data were collected using electronic health records and live multipurpose database. Dual-energy X-ray absorptiometry (DXA) scan results were reviewed to assess bone mineral density (BMD) both before the initiation of teriparatide treatment and after completion. Data were analysed to provide insights into the demographic characteristics of the treated population, the efficacy of teriparatide based on BMD improvements, treatment adherence, and local compliance with national guidelines. Results Over the ten-year study period, a total of 480 patients were prescribed teriparatide - all women with an average age of 74 years. Alendronate was the most common first-line bisphosphonate. Participants suffered three fractures on average prior to commencing therapy. 224/480 were prescribed teriparatide biosimilar. Pre-treatment, the average T score was -2.7 for the lumbar spine and hip with -2.4 for the femoral neck. Post-treatment, these values improved to -2.2, -2.4 and -2.3, respectively. Treatment was well tolerated with 63.5% completing two years of therapy. During mean follow up of three years, only 10 patients (0.02%) suffered a fragility fracture. Conclusion To our knowledge, this is the largest real world study of teriparatide in nearly 500 patients. Our study demonstrates real world use of teriparatide in a multi-ethnic diverse setting. It shows that teriparatide is used predominantly in complex, multi-morbid older individuals with several prior fractures. Despite that, teriparatide remains effective for a wide range of individuals including those with inflammatory arthritis and/or concurrent steroid use. This is in line with recent meta-analysis of real-life teriparatide use in complex osteoporosis with multimorbidity. Although NICE stipulates minimum two fractures requirement (unless T score -4.0), in practice patients may have had more suggesting that clinicians are reserving it for high disease burden or there is a delay in diagnosis. We also demonstrate the large-scale clinical effectiveness of the biosimilar. Our study should enhance clinicians’ confidence in its prescribing. We believe that since the availability of more cost-effective teriparatide biosimilars, NICE ought to amend its guidance and provide easier access to therapies for better patient outcomes. Disclosure J. Begum: None. C. Fawehinmi: None. A. Fayyas: None. J. William: None. A. Butt: None. A. Butt: None. M.K. Nisar: None.