title: Effectiveness of teriparatide in postmenopausal women with osteoporosis and glucocorticoid use: 3-year results from the EFOS study.
abstract: OBJECTIVE
  To describe clinical fracture rates, back pain, and health-related quality of life (HRQOL) in postmenopausal women with osteoporosis who are receiving glucocorticoids (GC), during a 36-month study of teriparatide treatment for up to 18 months, with an additional 18-month followup period when patients were receiving other osteoporosis medications.
  
  
  METHODS
  A prospective, multinational, observational study. Data for clinical fractures, back pain (by visual analog scale; VAS) and HRQOL (by EQ-5D) were collected over 36 months. Fracture data were summarized in 6-month segments and analyzed using logistic regression with repeated measures. Changes from baseline in back pain VAS and EQ-VAS were analyzed.
  
  
  RESULTS
  Of 1581 enrolled women with followup data, 294 (18.6%) had antecedents of GC use. Of these, 49 (16.7%) patients sustained a total of 69 fractures during the 36-month study period. Adjusted odds of fracture were significantly decreased during the last year of followup compared with the first 6 months of teriparatide treatment: an 81% decrease in the 24 to < 30-month period (p < 0.05), and an 89% decrease in the 30 to < 36-month period (p < 0.05). There were significant reductions in back pain and improvements in HRQOL in both groups of GC users and nonusers.
  
  
  CONCLUSIONS
  Postmenopausal women with severe osteoporosis receiving GC, who were treated with teriparatide for up to 18 months, showed a reduced incidence of clinical fractures during the third year while receiving sequential osteoporosis treatments compared with the first 6 months, together with reduced back pain and improved HRQOL. Our results should be interpreted in the context of an uncontrolled observational study in a routine clinical setting.
authors.affiliation: Veterans Administration Hospital, Athens, Greece. dkarras@ath.forthnet.gr
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Karras
authors.forename: Ivaylo
authors.initials: I
authors.lastname: Stoykov
authors.forename: Willem F
authors.initials: WF
authors.lastname: Lems
authors.forename: Bente L
authors.initials: BL
authors.lastname: Langdahl
authors.forename: Östen
authors.initials: Ö
authors.lastname: Ljunggren
authors.forename: Annabel
authors.initials: A
authors.lastname: Barrett
authors.forename: J Bernard
authors.initials: JB
authors.lastname: Walsh
authors.forename: Astrid
authors.initials: A
authors.lastname: Fahrleitner-Pammer
authors.forename: Gerald
authors.initials: G
authors.lastname: Rajzbaum
authors.forename: Franz
authors.initials: F
authors.lastname: Jakob
authors.forename: Fernando
authors.initials: F
authors.lastname: Marin
mesh_terms: D000368:Aged; D001172:Arthritis, Rheumatoid / Q000188:drug therapy; D001416:Back Pain / Q000453:epidemiology / Q000517:prevention & control*; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000453:epidemiology / Q000517:prevention & control*; D005938:Glucocorticoids / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000139:chemically induced* / Q000150:complications / Q000188:drug therapy*; D010147:Pain Measurement; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy; D011788:Quality of Life; D012189:Retrospective Studies; D012307:Risk Factors; D019379:Teriparatide / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D050071:Bone Density Conservation Agents; D005938:Glucocorticoids; D019379:Teriparatide