BACKGROUND: Osteoporosis drugs might affect fracture-healing. We therefore studied the effects of teriparatide in comparison with risedronate on recovery after pertrochanteric hip fractures. METHODS: The study was a randomized, multicenter, active-controlled, 78-week trial comparing teriparatide (20 μg/day) with risedronate (35 mg/week) initiated within 2 weeks after fixation of a low-trauma pertrochanteric hip fracture (AO/OTA 31-A1 or 31-A2). The main inclusion criteria were a bone mineral density T-score of ≤-2.0 and 25-OH-vitamin D of ≥9.2 ng/mL. During the first 26 weeks, patients received study medication with oral or injectable placebo plus calcium and vitamin D in a double-blinded fashion. Secondary (Timed Up-and-Go [TUG] test, hip pain, Short Form [SF]-36 health status, and safety) and exploratory (radiographic outcomes and ability to walk) 26-week end points are reported. RESULTS: Of the 224 patients who were randomized, 171 (86 teriparatide, 85 risedronate) were included in the analysis. The mean age was 77 ± 8 years, 77% were female, and 26% had a prior history of low-trauma fracture. The teriparatide group completed the TUG test in a shorter time at 6, 12, 18, and 26 weeks (differences of -5.7, -4.4, -3.1, and -3.1 seconds, respectively; p = 0.021 for the overall difference). They also reported less pain on a visual analog scale immediately after the TUG test at 12 and 18 weeks (adjusted absolute differences of 10.6 and 11.9 mm, respectively; p < 0.05). There were no significant between-group differences in the SF-36 score, Charnley hip pain score, ability to walk, or use of walking aids during follow-up. Radiographic healing at 6, 12, and 26 weeks, mechanical failure of the implant (teriparatide, 7; risedronate, 8), loss of reduction (teriparatide, 2; risedronate, 4), and nonunion (0 cases) were not significantly different. Mild hypercalcemia and hyperuricemia were more frequent with teriparatide. CONCLUSIONS: Teriparatide was associated with less pain and a shorter time to complete the TUG test between 6 and 26 weeks compared with risedronate. Other fracture-recovery outcomes were similar. The results should be interpreted with caution as these were secondary end points. LEVEL OF EVIDENCE: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

3rd Orthopaedic Department Aristotle University of Thessaloniki Papageorgiou General Hospital Thessaloniki Greece

Department of Biomedical Surgical and Dental Sciences University of Milan c o 1 Division of Orthopaedics and Traumatology A O Orthopaedic Institute Milan Italy

Department of Clinical and Experimental Medicine Linköping University Linköping Sweden

Department of Orthopaedic Surgery and Traumatology Odense University Hospital Odense Denmark

Department of Orthopaedic Surgery and Traumatology Santiago de Compostela University Hospital Health Research Institute University of Santiago de Compostela Santiago de Compostela Spain

Eli Lilly Research Centre Windlesham United Kingdom

Eli Lilly Vienna Austria

I3MTO Orléans University Orléans France

Institute of Clinical Research University of Southern Denmark Odense Denmark

Institute of Rheumatology and Faculty of Medicine 1 Charles University Prague Czech Republic

Internal Medicine Hospital San Pablo Barcelona Spain

IPROS Department of Rheumatology C H R Orléans Orléans France

Orthopaedic Surgery Oslo University Hospital Oslo Norway

Orthopaedic Surgery University Hospital Aarhus Denmark

Orthopaedic Surgery University Tor Vergata Rome Italy

Osteoporosis Center University Hospital Monterrey Mexico

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