VERO: VERtebral Fracture Treatment Comparisons in Osteoporotic Women

Sponsor
Eli Lilly and Company (Industry)
Overall Status
Completed
CT.gov ID
NCT01709110
Collaborator
(none)
1,366
103
2
45
13.3
0.3

Study Details

Study Description

Brief Summary

The primary purpose of participation in this study is to answer whether teriparatide is superior to risedronate in reducing the occurrence of new vertebral fractures during 24 months of therapy.

Condition or Disease Intervention/Treatment Phase
Phase 4

Study Design

Study Type:
Interventional
Actual Enrollment :
1366 participants
Allocation:
Randomized
Intervention Model:
Parallel Assignment
Masking:
Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose:
Treatment
Official Title:
Teriparatide and Risedronate in the Treatment of Patients With Severe Postmenopausal Osteoporosis: Comparative Effects on Vertebral Fractures
Study Start Date :
Oct 1, 2012
Actual Primary Completion Date :
Jul 1, 2016
Actual Study Completion Date :
Jul 1, 2016

Arms and Interventions

Arm Intervention/Treatment
Experimental: Teriparatide

Teriparatide 20 microgram (µg) administered by subcutaneous (SC) injection once daily for 24 months. Placebo given orally once weekly for 24 months. Elemental Calcium 500 to 1000 milligram per day and Vitamin D 400 to 800 International Units per day, both administered orally once daily while receiving treatment.

Drug: Teriparatide
Administered SC
Other Names:
  • LY333334
  • Forteo
  • Forsteo
  • Drug: Placebo
    Teriparatide arm placebo administered orally. Risedronate arm placebo administered SC.

    Drug: Calcium
    Administered orally

    Drug: Vitamin D
    Administered orally

    Active Comparator: Risedronate

    Risedronate 35 milligram (mg) administered orally once weekly for 24 months. Placebo given by SC injection once daily for 24 months. Elemental Calcium 500 to 1000 milligram per day and Vitamin D 400 to 800 International Units per day, both administered orally once daily while receiving treatment.

    Drug: Risedronate
    Administered orally

    Drug: Placebo
    Teriparatide arm placebo administered orally. Risedronate arm placebo administered SC.

    Drug: Calcium
    Administered orally

    Drug: Vitamin D
    Administered orally

    Outcome Measures

    Primary Outcome Measures

    1. Proportion of Participants With New Vertebral Fractures [Baseline through 24 Months]

      The incidence of new vertebral fractures was assessed by quantitative vertebral morphometry measurements (QM) with qualitative visual semiquantitative grading (SQ) confirmation. A new vertebral fracture was diagnosed in a vertebra that was non-fractured at the baseline radiological examination. It was defined as a loss of vertebral body height of at least 20% and 4 mm from the baseline radiograph by vertebral QM, based upon placement of six points by a trained, central reader. Any fractures identified by QM were confirmed using SQ: if the vertebral body also had an increase of one or more severity grade, it was considered an incident vertebral fracture.

    Secondary Outcome Measures

    1. Proportion of Participants With Pooled New and Worsening Vertebral Fractures [Baseline through 24 Months]

      Worsening of a pre-existing fracture was considered if the decrease in vertebral height was at least one severity grade in the semi-quantitative assessment, confirmed by a trained central reader, where vertebrae were graded as normal (SQ0) or as with mild (SQ1), moderate (SQ2), or severe (SQ3) fractures, defined as ~20 to 25% (mild), ~25 to 40% (moderate) or ~40% or more (severe) decrease in anterior, central, or posterior vertebral height (T4 to L4).

    2. Proportion of Participants With Pooled Clinical Vertebral and Non-Vertebral Fragility Fractures [Baseline through 24 Months]

      A clinical vertebral fracture was defined as a new or worsening vertebral fracture, confirmed by radiography, that was associated with signs and symptoms highly suggestive of a vertebral fracture. All non-vertebral fractures that occurred and were diagnosed between visits required the confirmation by the site investigators after evaluating the original x-ray film(s), the radiology or surgical report. For clinical vertebral fractures, the final confirmation of the diagnosis required the centralized evaluation by a trained, independent reader.

    3. Proportion of Participants With Non-Vertebral Fragility Fractures [Baseline through 24 Months]

      A non-vertebral fracture is a fracture at any of the following non-vertebral sites: clavicle, scapula, ribs, sternum, sacrum, coccyx, humerus, radius, ulna, carpus, pelvis, hip, femur, patella, tibia, fibula, ankle, calcaneus, tarsus, and metatarsal. Non-vertebral fractures were determined by direct questioning at each visit, and confirmed by the site investigators by x-ray, radiology or surgical report. Fractures resulting from a severe trauma such as a traffic collision, a beating, or having been struck by a falling or moving object were not considered fragility fractures but traumatic fractures.

    4. Proportion of Participants With Major Non-Vertebral Fragility Fractures [Baseline through 24 Months]

      A major non-vertebral fracture is a fracture at any of the following non-vertebral sites hip, radius, humerus, ribs, pelvis, tibia and femur. Non-vertebral fractures were determined by direct questioning at each visit, and confirmed by the site investigators by x-ray, radiology or surgical report. Fractures resulting from a severe trauma such as a traffic collision, a beating, or having been struck by a falling or moving.

    5. Proportion of Participants With New Moderate and/or Severe Vertebral Fractures [Baseline through 24 Months]

      Vertebrae were graded as moderate (SQ2), or severe (SQ3) fractures, based on ~25 to 40% (moderate) or ~40% or more (severe) decrease in anterior, central, or posterior vertebral height (T4 through L4).

    6. Proportion of Participants With New Multiple (2 or More) Vertebral Fractures [Baseline through 24 Months]

    7. Proportion of Participants With Pooled Fragility and Traumatic Non-Vertebral Fractures [Baseline through 24 Months]

      Traumatic fractures were considered if resulting from a severe trauma such as a traffic collision, a beating, or having been struck by a falling or moving object.

    8. Change From Baseline to 24 Months Endpoint in Height [Baseline, 24 Months]

    9. Change From Baseline to 24 Months Endpoint in Back Pain Using an 11-point Numerical Pain Rating Scale [Baseline, 24 Months]

      Participants rated the worst back pain during the 24 hours preceding the visit at baseline and each post-baseline visit. An 11-point numerical back pain rating scale (rated from 0 = no back pain to 10 = worst possible back pain) was used.

    10. Change From Baseline to 24 Months Endpoint in the European Quality of Life Questionnaire [EQ-5D-5L] (UK) [Baseline, 24 Months]

      The EQ-5D-5L is a generic, multidimensional, health-related, quality-of-life instrument completed on five dimensions to measure health-related quality of life. The profile allowed participants to rate their health state in five health domains: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression using a five level scale (no problems, slight problems, moderate problems, severe problems, and unable to/extreme problems). The responses are used to derive the health state index scores using the United Kingdom (UK) algorithm, with scores ranging from -0.59 to 1.0. A higher score indicates better health state.

    11. Change From Baseline to 24 Months Endpoint in the European Quality of Life Questionnaire [EQ-5D-5L] (US) [Baseline, 24 Months]

      The EQ-5D-5L is a generic, multidimensional, health-related, quality-of-life instrument completed on five dimensions to measure health-related quality of life. The profile allowed participants to rate their health state in five health domains: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression using a five level scale (no problems, slight problems, moderate problems, severe problems, and unable to/extreme problems). The responses are used to derive the health state index scores using the United States (US) cross walk algorithm, with scores ranging from -0.11 to 1.0. A higher score indicates better health state.

    Eligibility Criteria

    Criteria

    Ages Eligible for Study:
    45 Years and Older
    Sexes Eligible for Study:
    Female
    Accepts Healthy Volunteers:
    No
    Inclusion Criteria:
    • Postmenopausal women with osteoporosis, as defined by low bone mineral density (BMD), i.e. anterior-posterior lumbar spine, total hip or femoral neck BMD ≥1.5 standard deviations below the average BMD for young, healthy, non-Hispanic, Caucasian women

    • A minimum of 2 moderate or 1 severe vertebral fragility fractures (confirmed by central reader) were required

    Exclusion Criteria:
    • Increased risk of osteosarcoma

    • History of unresolved skeletal diseases that affect bone metabolism

    • History of atypical subtrochanteric or diaphyseal femoral fractures

    • Abnormally high or low calcium levels

    • Abnormally high parathyroid hormone (PTH) levels

    • Severe vitamin D deficiency

    • Abnormal thyroid function not corrected by therapy

    • History of malignant neoplasms in the last 5 years

    • Active liver disease, clinical jaundice

    • Significant impairment of hepatic or renal function

    • History of nephro- or urolithiasis

    • Previous or planned kypho- or vertebroplasty

    • Active or risk for osteonecrosis of the jaw

    • Active or recent history of upper gastrointestinal disorders

    • Unable to stand or sit in the upright position for at least 30 minutes

    Contacts and Locations

    Locations

    Site City State Country Postal Code
    1 For additional information regarding investigative sites for this trial, contact 1-877-CTLILLY (1-877-285-4559, 1-317-615-4559) Mon - Fri from 9 AM to 5 PM Eastern Time (UTC/GMT - 5 hours, EST), or speak with your personal physician. Birmingham Alabama United States 35294
    2 For additional information regarding investigative sites for this trial, contact 1-877-CTLILLY (1-877-285-4559, 1-317-615-4559) Mon - Fri from 9 AM to 5 PM Eastern Time (UTC/GMT - 5 hours, EST), or speak with your personal physician. Concord California United States 94520
    3 For additional information regarding investigative sites for this trial, contact 1-877-CTLILLY (1-877-285-4559, 1-317-615-4559) Mon - Fri from 9 AM to 5 PM Eastern Time (UTC/GMT - 5 hours, EST), or speak with your personal physician. Fresno California United States 93720
    4 For additional information regarding investigative sites for this trial, contact 1-877-CTLILLY (1-877-285-4559, 1-317-615-4559) Mon - Fri from 9 AM to 5 PM Eastern Time (UTC/GMT - 5 hours, EST), or speak with your personal physician. Laguna Hills California United States 92653
    5 For additional information regarding investigative sites for this trial, contact 1-877-CTLILLY (1-877-285-4559, 1-317-615-4559) Mon - Fri from 9 AM to 5 PM Eastern Time (UTC/GMT - 5 hours, EST), or speak with your personal physician. Lancaster California United States 93534
    6 For additional information regarding investigative sites for this trial, contact 1-877-CTLILLY (1-877-285-4559, 1-317-615-4559) Mon - Fri from 9 AM to 5 PM Eastern Time (UTC/GMT - 5 hours, EST), or speak with your personal physician. Tustin California United States 92780
    7 For additional information regarding investigative sites for this trial, contact 1-877-CTLILLY (1-877-285-4559, 1-317-615-4559) Mon - Fri from 9 AM to 5 PM Eastern Time (UTC/GMT - 5 hours, EST), or speak with your personal physician. Lakewood Colorado United States 80227
    8 For additional information regarding investigative sites for this trial, contact 1-877-CTLILLY (1-877-285-4559, 1-317-615-4559) Mon - Fri from 9 AM to 5 PM Eastern Time (UTC/GMT - 5 hours, EST), or speak with your personal physician. Danbury Connecticut United States 06810
    9 For additional information regarding investigative sites for this trial, contact 1-877-CTLILLY (1-877-285-4559, 1-317-615-4559) Mon - Fri from 9 AM to 5 PM Eastern Time (UTC/GMT - 5 hours, EST), or speak with your personal physician. Orlando Florida United States 32804
    10 For additional information regarding investigative sites for this trial, contact 1-877-CTLILLY (1-877-285-4559, 1-317-615-4559) Mon - Fri from 9 AM to 5 PM Eastern Time (UTC/GMT - 5 hours, EST), or speak with your personal physician. Gainesville Georgia United States 30501
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    12 For additional information regarding investigative sites for this trial, contact 1-877-CTLILLY (1-877-285-4559, 1-317-615-4559) Mon - Fri from 9 AM to 5 PM Eastern Time (UTC/GMT - 5 hours, EST), or speak with your personal physician. Indianapolis Indiana United States 46202
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    15 For additional information regarding investigative sites for this trial, contact 1-877-CTLILLY (1-877-285-4559, 1-317-615-4559) Mon - Fri from 9 AM to 5 PM Eastern Time (UTC/GMT - 5 hours, EST), or speak with your personal physician. Detroit Michigan United States 48202
    16 For additional information regarding investigative sites for this trial, contact 1-877-CTLILLY (1-877-285-4559, 1-317-615-4559) Mon - Fri from 9 AM to 5 PM Eastern Time (UTC/GMT - 5 hours, EST), or speak with your personal physician. Omaha Nebraska United States 68131
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    26 For additional information regarding investigative sites for this trial, contact 1-877-CTLILLY (1-877-285-4559, 1-317-615-4559) Mon - Fri from 9 AM to 5 PM Eastern Time (UTC/GMT - 5 hours, EST), or speak with your personal physician. Wyomissing Pennsylvania United States 19610
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    28 For additional information regarding investigative sites for this trial, contact 1-877-CTLILLY (1-877-285-4559, 1-317-615-4559) Mon - Fri from 9 AM to 5 PM Eastern Time (UTC/GMT - 5 hours, EST), or speak with your personal physician. Seattle Washington United States 98122
    29 For additional information regarding investigative sites for this trial, contact 1-877-CTLILLY (1-877-285-4559, 1-317-615-4559) Mon - Fri from 9 AM to 5 PM Eastern Time (UTC/GMT - 5 hours, EST), or speak with your personal physician. Spokane Washington United States 99204
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    31 For additional information regarding investigative sites for this trial, contact 1-877-CTLILLY (1-877-285-4559, 1-317-615-4559) Mon - Fri from 9 AM to 5 PM Eastern Time (UTC/GMT - 5 hours, EST), or speak with your personal physician. Buenos Aires Argentina C1128AAF
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    39 For additional information regarding investigative sites for this trial, contact 1-877-CTLILLY (1-877-285-4559, 1-317-615-4559) Mon - Fri from 9 AM to 5 PM Eastern Time (UTC/GMT - 5 hours, EST), or speak with your personal physician. Genk Belgium 3600
    40 For additional information regarding investigative sites for this trial, contact 1-877-CTLILLY (1-877-285-4559, 1-317-615-4559) Mon - Fri from 9 AM to 5 PM Eastern Time (UTC/GMT - 5 hours, EST), or speak with your personal physician. Gent Belgium 9000
    41 For additional information regarding investigative sites for this trial, contact 1-877-CTLILLY (1-877-285-4559, 1-317-615-4559) Mon - Fri from 9 AM to 5 PM Eastern Time (UTC/GMT - 5 hours, EST), or speak with your personal physician. Gilly Belgium 6060
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    67 For additional information regarding investigative sites for this trial, contact 1-877-CTLILLY (1-877-285-4559, 1-317-615-4559) Mon - Fri from 9 AM to 5 PM Eastern Time (UTC/GMT - 5 hours, EST), or speak with your personal physician. Saint-Etienne France 42055
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    70 For additional information regarding investigative sites for this trial, contact 1-877-CTLILLY (1-877-285-4559, 1-317-615-4559) Mon - Fri from 9 AM to 5 PM Eastern Time (UTC/GMT - 5 hours, EST), or speak with your personal physician. Frankfurt Germany 60528
    71 For additional information regarding investigative sites for this trial, contact 1-877-CTLILLY (1-877-285-4559, 1-317-615-4559) Mon - Fri from 9 AM to 5 PM Eastern Time (UTC/GMT - 5 hours, EST), or speak with your personal physician. Hamburg Germany 22415
    72 For additional information regarding investigative sites for this trial, contact 1-877-CTLILLY (1-877-285-4559, 1-317-615-4559) Mon - Fri from 9 AM to 5 PM Eastern Time (UTC/GMT - 5 hours, EST), or speak with your personal physician. Leipzig Germany 04103
    73 For additional information regarding investigative sites for this trial, contact 1-877-CTLILLY (1-877-285-4559, 1-317-615-4559) Mon - Fri from 9 AM to 5 PM Eastern Time (UTC/GMT - 5 hours, EST), or speak with your personal physician. Magdeburg Germany 39110
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    Sponsors and Collaborators

    • Eli Lilly and Company

    Investigators

    • Study Director: Call 1-877-CTLILLY (1-877-285-4559) or 1-317-615-4559 Mon - Fri 9 AM - 5 PM Eastern time (UTC/GMT - 5 hours, EST), Eli Lilly and Company

    Study Documents (Full-Text)

    None provided.

    More Information

    Publications

    None provided.
    Responsible Party:
    Eli Lilly and Company
    ClinicalTrials.gov Identifier:
    NCT01709110
    Other Study ID Numbers:
    • 14536
    • B3D-EW-GHDW
    • 2012-000123-41
    First Posted:
    Oct 17, 2012
    Last Update Posted:
    Sep 23, 2019
    Last Verified:
    Sep 1, 2019
    Individual Participant Data (IPD) Sharing Statement:
    Yes
    Plan to Share IPD:
    Yes
    Keywords provided by Eli Lilly and Company
    Additional relevant MeSH terms:

    Study Results

    Participant Flow

    Recruitment Details
    Pre-assignment Detail
    Arm/Group Title Teriparatide Risedronate
    Arm/Group Description Teriparatide 20 microgram (µg) administered by subcutaneous (SC) injection once daily for 24 months. Placebo given orally once weekly for 24 months. Risedronate 35 milligram (mg) administered orally once weekly for 24 months. Placebo given by SC injection once daily for 24 months.
    Period Title: Overall Study
    STARTED 683 683
    Received at Least One Dose of Study Drug 680 680
    COMPLETED 498 515
    NOT COMPLETED 185 168

    Baseline Characteristics

    Arm/Group Title Teriparatide Risedronate Total
    Arm/Group Description Teriparatide 20 microgram administered by subcutaneous injection once daily for 24 months. Placebo given orally once weekly for 24 months. Risedronate 35 milligram administered orally once weekly for 24 months. Placebo given by SC injection once daily for 24 months. Total of all reporting groups
    Overall Participants 680 680 1360
    Age (years) [Mean (Standard Deviation) ]
    Mean (Standard Deviation) [years]
    72.6
    (8.77)
    71.6
    (8.58)
    72.1
    (8.68)
    Sex: Female, Male (Count of Participants)
    Female
    680
    100%
    680
    100%
    1360
    100%
    Male
    0
    0%
    0
    0%
    0
    0%
    Ethnicity (NIH/OMB) (Count of Participants)
    Hispanic or Latino
    104
    15.3%
    99
    14.6%
    203
    14.9%
    Not Hispanic or Latino
    310
    45.6%
    302
    44.4%
    612
    45%
    Unknown or Not Reported
    266
    39.1%
    279
    41%
    545
    40.1%
    Race (NIH/OMB) (Count of Participants)
    American Indian or Alaska Native
    1
    0.1%
    1
    0.1%
    2
    0.1%
    Asian
    4
    0.6%
    8
    1.2%
    12
    0.9%
    Native Hawaiian or Other Pacific Islander
    0
    0%
    0
    0%
    0
    0%
    Black or African American
    5
    0.7%
    15
    2.2%
    20
    1.5%
    White
    670
    98.5%
    653
    96%
    1323
    97.3%
    More than one race
    0
    0%
    3
    0.4%
    3
    0.2%
    Unknown or Not Reported
    0
    0%
    0
    0%
    0
    0%
    Region of Enrollment (Count of Participants)
    Argentina
    79
    11.6%
    78
    11.5%
    157
    11.5%
    Hungary
    68
    10%
    53
    7.8%
    121
    8.9%
    Czech Republic
    68
    10%
    68
    10%
    136
    10%
    United States
    55
    8.1%
    67
    9.9%
    122
    9%
    Spain
    66
    9.7%
    55
    8.1%
    121
    8.9%
    Greece
    27
    4%
    13
    1.9%
    40
    2.9%
    Canada
    36
    5.3%
    33
    4.9%
    69
    5.1%
    Austria
    24
    3.5%
    29
    4.3%
    53
    3.9%
    Belgium
    43
    6.3%
    45
    6.6%
    88
    6.5%
    Poland
    55
    8.1%
    63
    9.3%
    118
    8.7%
    Brazil
    63
    9.3%
    81
    11.9%
    144
    10.6%
    Italy
    33
    4.9%
    36
    5.3%
    69
    5.1%
    France
    26
    3.8%
    29
    4.3%
    55
    4%
    Germany
    37
    5.4%
    30
    4.4%
    67
    4.9%
    Distribution of Stratification Factors (Count of Participants)
    Vertebral Fracture with Bisphosphonate Use
    82
    12.1%
    79
    11.6%
    161
    11.8%
    With Vertebral Fracture without Bisphosphonate Use
    170
    25%
    165
    24.3%
    335
    24.6%
    Without Vertebral Fracture with Bisphosphonate Use
    184
    27.1%
    189
    27.8%
    373
    27.4%
    Without Vertebral Fracture without Bisphosphonate
    244
    35.9%
    247
    36.3%
    491
    36.1%
    Bone Mineral Density (BMD) (Gram per square centimeter (g/cm2)) [Mean (Standard Deviation) ]
    Lumbar Spine
    0.858
    (0.1541)
    0.856
    (0.1473)
    0.857
    (0.1506)
    Femoral Neck
    0.662
    (0.1085)
    0.667
    (0.1129)
    0.664
    (0.1107)
    Total Hip
    0.736
    (0.1065)
    0.735
    (0.1165)
    0.735
    (0.1116)
    Vertebral Fracture Status (Count of Participants)
    1 Fracture
    231
    34%
    240
    35.3%
    471
    34.6%
    2 Fractures
    178
    26.2%
    174
    25.6%
    352
    25.9%
    3 Fractures
    104
    15.3%
    101
    14.9%
    205
    15.1%
    4 Fractures
    60
    8.8%
    62
    9.1%
    122
    9%
    5 or More Fractures
    106
    15.6%
    102
    15%
    208
    15.3%

    Outcome Measures

    1. Primary Outcome
    Title Proportion of Participants With New Vertebral Fractures
    Description The incidence of new vertebral fractures was assessed by quantitative vertebral morphometry measurements (QM) with qualitative visual semiquantitative grading (SQ) confirmation. A new vertebral fracture was diagnosed in a vertebra that was non-fractured at the baseline radiological examination. It was defined as a loss of vertebral body height of at least 20% and 4 mm from the baseline radiograph by vertebral QM, based upon placement of six points by a trained, central reader. Any fractures identified by QM were confirmed using SQ: if the vertebral body also had an increase of one or more severity grade, it was considered an incident vertebral fracture.
    Time Frame Baseline through 24 Months

    Outcome Measure Data

    Analysis Population Description
    Full analysis set-modified: participants with baseline and at least one post-baseline spinal radiograph evaluable to assess the vertebral fracture status after 24 month of therapy.
    Arm/Group Title Teriparatide Risedronate
    Arm/Group Description Teriparatide 20 microgram administered by subcutaneous injection once daily for 24 months. Placebo given orally once weekly for 24 months. Risedronate 35 milligram administered orally once weekly for 24 months. Placebo given by SC injection once daily for 24 months.
    Measure Participants 516 533
    Number [Participants (with at least one event)]
    28
    4.1%
    64
    9.4%
    Statistical Analysis 1
    Statistical Analysis Overview Comparison Group Selection Teriparatide, Risedronate
    Comments
    Type of Statistical Test Superiority
    Comments
    Statistical Test of Hypothesis p-Value 0.000094
    Comments
    Method Cochran-Mantel-Haenszel
    Comments Cochran-Mantel-Haenszel test was adjusted for the antecedent of recent clinical vertebral fractures and recent bisphosphonate use.
    Method of Estimation Estimation Parameter Odds Ratio (OR)
    Estimated Value 0.4071
    Confidence Interval (2-Sided) 95%
    0.256 to 0.647
    Parameter Dispersion Type:
    Value:
    Estimation Comments
    Statistical Analysis 2
    Statistical Analysis Overview Comparison Group Selection Teriparatide, Risedronate
    Comments
    Type of Statistical Test Superiority
    Comments
    Statistical Test of Hypothesis p-Value 0.000094
    Comments
    Method Cochran-Mantel-Haenszel
    Comments Cochran-Mantel-Haenszel test was adjusted for the antecedent of recent clinical vertebral fractures and recent bisphosphonate use.
    Method of Estimation Estimation Parameter Risk Ratio (RR)
    Estimated Value 0.4431
    Confidence Interval (2-Sided) 95%
    0.290 to 0.677
    Parameter Dispersion Type:
    Value:
    Estimation Comments
    2. Secondary Outcome
    Title Proportion of Participants With Pooled New and Worsening Vertebral Fractures
    Description Worsening of a pre-existing fracture was considered if the decrease in vertebral height was at least one severity grade in the semi-quantitative assessment, confirmed by a trained central reader, where vertebrae were graded as normal (SQ0) or as with mild (SQ1), moderate (SQ2), or severe (SQ3) fractures, defined as ~20 to 25% (mild), ~25 to 40% (moderate) or ~40% or more (severe) decrease in anterior, central, or posterior vertebral height (T4 to L4).
    Time Frame Baseline through 24 Months

    Outcome Measure Data

    Analysis Population Description
    Full analysis set-modified: participants with baseline and at least one post-baseline spinal radiograph evaluable to assess the vertebral fracture status after 24 month of therapy.
    Arm/Group Title Teriparatide Risedronate
    Arm/Group Description Teriparatide 20 microgram administered by subcutaneous injection once daily for 24 months. Placebo given orally once weekly for 24 months. Risedronate 35 milligram administered orally once weekly for 24 months. Placebo given by SC injection once daily for 24 months.
    Measure Participants 516 533
    Number [Participants (with at least one event)]
    31
    4.6%
    69
    10.1%
    Statistical Analysis 1
    Statistical Analysis Overview Comparison Group Selection Teriparatide, Risedronate
    Comments
    Type of Statistical Test Superiority
    Comments
    Statistical Test of Hypothesis p-Value 0.000075
    Comments
    Method Cochran-Mantel-Haenszel
    Comments Cochran-Mantel-Haenszel was adjusted for the antecedent of recent clinical vertebral fractures and recent bisphosphonate use.
    Method of Estimation Estimation Parameter Odds Ratio (OR)
    Estimated Value 0.4187
    Confidence Interval (2-Sided) 95%
    0.269 to 0.652
    Parameter Dispersion Type:
    Value:
    Estimation Comments
    Statistical Analysis 2
    Statistical Analysis Overview Comparison Group Selection Teriparatide, Risedronate
    Comments
    Type of Statistical Test Superiority
    Comments
    Statistical Test of Hypothesis p-Value 0.000075
    Comments
    Method Cochran-Mantel-Haenszel
    Comments Cochran-Mantel-Haenszel was adjusted for the antecedent of recent clinical vertebral fractures and recent bisphosphonate use.
    Method of Estimation Estimation Parameter Risk Ratio (RR)
    Estimated Value 0.4561
    Confidence Interval (2-Sided) 95%
    0.305 to 0.682
    Parameter Dispersion Type:
    Value:
    Estimation Comments
    3. Secondary Outcome
    Title Proportion of Participants With Pooled Clinical Vertebral and Non-Vertebral Fragility Fractures
    Description A clinical vertebral fracture was defined as a new or worsening vertebral fracture, confirmed by radiography, that was associated with signs and symptoms highly suggestive of a vertebral fracture. All non-vertebral fractures that occurred and were diagnosed between visits required the confirmation by the site investigators after evaluating the original x-ray film(s), the radiology or surgical report. For clinical vertebral fractures, the final confirmation of the diagnosis required the centralized evaluation by a trained, independent reader.
    Time Frame Baseline through 24 Months

    Outcome Measure Data

    Analysis Population Description
    Full analysis set: all participants who received at least one dose of study drug and had evaluable data.
    Arm/Group Title Teriparatide Risedronate
    Arm/Group Description Teriparatide 20 microgram administered by subcutaneous injection once daily for 24 months. Placebo given orally once weekly for 24 months. Risedronate 35 milligram administered orally once weekly for 24 months. Placebo given by SC injection once daily for 24 months.
    Measure Participants 680 680
    Number [Participants (with at least one event)]
    30
    4.4%
    61
    9%
    Statistical Analysis 1
    Statistical Analysis Overview Comparison Group Selection Teriparatide, Risedronate
    Comments
    Type of Statistical Test Superiority
    Comments
    Statistical Test of Hypothesis p-Value 0.000869
    Comments
    Method Stratified Log Rank
    Comments Stratified Log Rank test was adjusted for the antecedent of recent clinical vertebral fractures and recent bisphosphonate use.
    Method of Estimation Estimation Parameter Stratified Hazard Ratio (HR)
    Estimated Value 0.4831
    Confidence Interval (2-Sided) 95%
    0.316 to 0.739
    Parameter Dispersion Type:
    Value:
    Estimation Comments The Stratified Hazard Ratio estimate and corresponding 95% CI were obtained from the number of observed and expected events as part of the stratified log-rank test calculations.
    4. Secondary Outcome
    Title Proportion of Participants With Non-Vertebral Fragility Fractures
    Description A non-vertebral fracture is a fracture at any of the following non-vertebral sites: clavicle, scapula, ribs, sternum, sacrum, coccyx, humerus, radius, ulna, carpus, pelvis, hip, femur, patella, tibia, fibula, ankle, calcaneus, tarsus, and metatarsal. Non-vertebral fractures were determined by direct questioning at each visit, and confirmed by the site investigators by x-ray, radiology or surgical report. Fractures resulting from a severe trauma such as a traffic collision, a beating, or having been struck by a falling or moving object were not considered fragility fractures but traumatic fractures.
    Time Frame Baseline through 24 Months

    Outcome Measure Data

    Analysis Population Description
    Full analysis set: all participants who received at least one dose of study drug and had evaluable data.
    Arm/Group Title Teriparatide Risedronate
    Arm/Group Description Teriparatide 20 microgram administered by subcutaneous injection once daily for 24 months. Placebo given orally once weekly for 24 months. Risedronate 35 milligram administered orally once weekly for 24 months. Placebo given by SC injection once daily for 24 months.
    Measure Participants 680 680
    Number [Participants (with at least one event)]
    25
    3.7%
    38
    5.6%
    Statistical Analysis 1
    Statistical Analysis Overview Comparison Group Selection Teriparatide, Risedronate
    Comments
    Type of Statistical Test Superiority
    Comments
    Statistical Test of Hypothesis p-Value 0.099023
    Comments
    Method Stratified Log Rank
    Comments Stratified Log Rank test was adjusted for the antecedent of recent clinical vertebral fractures and recent bisphosphonate use.
    Method of Estimation Estimation Parameter Stratified Hazard Ratio (HR)
    Estimated Value 0.6553
    Confidence Interval (2-Sided) 95%
    0.390 to 1.101
    Parameter Dispersion Type:
    Value:
    Estimation Comments The Stratified Hazard Ratio estimate and corresponding 95% CI were obtained from the number of observed and expected events as part of the stratified log-rank test calculations.
    5. Secondary Outcome
    Title Proportion of Participants With Major Non-Vertebral Fragility Fractures
    Description A major non-vertebral fracture is a fracture at any of the following non-vertebral sites hip, radius, humerus, ribs, pelvis, tibia and femur. Non-vertebral fractures were determined by direct questioning at each visit, and confirmed by the site investigators by x-ray, radiology or surgical report. Fractures resulting from a severe trauma such as a traffic collision, a beating, or having been struck by a falling or moving.
    Time Frame Baseline through 24 Months

    Outcome Measure Data

    Analysis Population Description
    Full analysis set: all participants who received at least one dose of study drug and had evaluable data.
    Arm/Group Title Teriparatide Risedronate
    Arm/Group Description Teriparatide 20 microgram administered by subcutaneous injection once daily for 24 months. Placebo given orally once weekly for 24 months. Risedronate 35 milligram administered orally once weekly for 24 months. Placebo given by SC injection once daily for 24 months.
    Measure Participants 680 680
    Number [Participants (with at least one event)]
    18
    2.6%
    31
    4.6%
    Statistical Analysis 1
    Statistical Analysis Overview Comparison Group Selection Teriparatide, Risedronate
    Comments
    Type of Statistical Test Superiority
    Comments
    Statistical Test of Hypothesis p-Value 0.062432
    Comments
    Method Stratified Log Rank
    Comments Stratified Log Rank test was adjusted for the antecedent of recent clinical vertebral fractures and recent bisphosphonate use.
    Method of Estimation Estimation Parameter Stratified Hazard Ratio (HR)
    Estimated Value 0.5786
    Confidence Interval (2-Sided) 95%
    0.318 to 1.052
    Parameter Dispersion Type:
    Value:
    Estimation Comments The Stratified Hazard Ratio estimate and corresponding 95% CI were obtained from the number of observed and expected events as part of the stratified log-rank test calculations.
    6. Secondary Outcome
    Title Proportion of Participants With New Moderate and/or Severe Vertebral Fractures
    Description Vertebrae were graded as moderate (SQ2), or severe (SQ3) fractures, based on ~25 to 40% (moderate) or ~40% or more (severe) decrease in anterior, central, or posterior vertebral height (T4 through L4).
    Time Frame Baseline through 24 Months

    Outcome Measure Data

    Analysis Population Description
    Full analysis set-modified: participants with baseline and at least one post-baseline spinal radiograph evaluable to assess the vertebral fracture status after 24 month of therapy.
    Arm/Group Title Teriparatide Risedronate
    Arm/Group Description Teriparatide 20 microgram administered by subcutaneous injection once daily for 24 months. Placebo given orally once weekly for 24 months. Risedronate 35 milligram administered orally once weekly for 24 months. Placebo given by SC injection once daily for 24 months.
    Measure Participants 516 533
    Number [Participants (with at least one event)]
    26
    3.8%
    63
    9.3%
    Statistical Analysis 1
    Statistical Analysis Overview Comparison Group Selection Teriparatide, Risedronate
    Comments
    Type of Statistical Test Superiority
    Comments
    Statistical Test of Hypothesis p-Value <0.001
    Comments
    Method Cochran-Mantel-Haenszel
    Comments Cochran-Mantel-Haenszel test was adjusted for the antecedent of recent clinical vertebral fractures and recent bisphosphonate use.
    Method of Estimation Estimation Parameter Odds Ratio (OR)
    Estimated Value 0.3812
    Confidence Interval (2-Sided) 95%
    0.237 to 0.614
    Parameter Dispersion Type:
    Value:
    Estimation Comments
    Statistical Analysis 2
    Statistical Analysis Overview Comparison Group Selection Teriparatide, Risedronate
    Comments
    Type of Statistical Test Superiority
    Comments
    Statistical Test of Hypothesis p-Value <0.001
    Comments
    Method Cochran-Mantel-Haenszel
    Comments Cochran-Mantel-Haenszel test was adjusted for the antecedent of recent clinical vertebral fractures and recent bisphosphonate use.
    Method of Estimation Estimation Parameter Risk Ratio (RR)
    Estimated Value 0.4173
    Confidence Interval (2-Sided) 95%
    0.270 to 0.646
    Parameter Dispersion Type:
    Value:
    Estimation Comments
    7. Secondary Outcome
    Title Proportion of Participants With New Multiple (2 or More) Vertebral Fractures
    Description
    Time Frame Baseline through 24 Months

    Outcome Measure Data

    Analysis Population Description
    Full analysis set-modified: participants with baseline and at least one post-baseline spinal radiograph evaluable to assess the vertebral fracture status after 24 month of therapy.
    Arm/Group Title Teriparatide Risedronate
    Arm/Group Description Teriparatide 20 microgram administered by subcutaneous injection once daily for 24 months. Placebo given orally once weekly for 24 months. Risedronate 35 milligram administered orally once weekly for 24 months. Placebo given by SC injection once daily for 24 months.
    Measure Participants 516 533
    Number [Participants (with at least one event)]
    2
    0.3%
    12
    1.8%
    Statistical Analysis 1
    Statistical Analysis Overview Comparison Group Selection Teriparatide, Risedronate
    Comments
    Type of Statistical Test Superiority
    Comments
    Statistical Test of Hypothesis p-Value 0.007
    Comments
    Method Cochran-Mantel-Haenszel
    Comments Cochran-Mantel-Haenszel test was adjusted for the antecedent of recent clinical vertebral fractures and recent bisphosphonate use.
    Method of Estimation Estimation Parameter Odds Ratio (OR)
    Estimated Value 0.1593
    Confidence Interval (2-Sided) 95%
    0.035 to 0.728
    Parameter Dispersion Type:
    Value:
    Estimation Comments
    Statistical Analysis 2
    Statistical Analysis Overview Comparison Group Selection Teriparatide, Risedronate
    Comments
    Type of Statistical Test Superiority
    Comments
    Statistical Test of Hypothesis p-Value 0.007
    Comments
    Method Cochran-Mantel-Haenszel
    Comments Cochran-Mantel-Haenszel test was adjusted for the antecedent of recent clinical vertebral fractures and recent bisphosphonate use.
    Method of Estimation Estimation Parameter Risk Ratio (RR)
    Estimated Value 0.1643
    Confidence Interval (2-Sided) 95%
    0.036 to 0.744
    Parameter Dispersion Type:
    Value:
    Estimation Comments
    8. Secondary Outcome
    Title Proportion of Participants With Pooled Fragility and Traumatic Non-Vertebral Fractures
    Description Traumatic fractures were considered if resulting from a severe trauma such as a traffic collision, a beating, or having been struck by a falling or moving object.
    Time Frame Baseline through 24 Months

    Outcome Measure Data

    Analysis Population Description
    Full analysis set: all participants who received at least one dose of study drug and had evaluable data.
    Arm/Group Title Teriparatide Risedronate
    Arm/Group Description Teriparatide 20 microgram administered by subcutaneous injection once daily for 24 months. Placebo given orally once weekly for 24 months. Risedronate 35 milligram administered orally once weekly for 24 months. Placebo given by SC injection once daily for 24 months.
    Measure Participants 680 680
    Number [Participants (with at least one event)]
    40
    5.9%
    57
    8.4%
    Statistical Analysis 1
    Statistical Analysis Overview Comparison Group Selection Teriparatide, Risedronate
    Comments
    Type of Statistical Test Superiority
    Comments
    Statistical Test of Hypothesis p-Value 0.078
    Comments
    Method Stratified Log Rank
    Comments Stratified Log Rank test was adjusted for the antecedent of recent clinical vertebral fractures and recent bisphosphonate use.
    Method of Estimation Estimation Parameter Stratified Hazard Ratio (HR)
    Estimated Value 0.6960
    Confidence Interval (2-Sided) 95%
    0.461 to 1.050
    Parameter Dispersion Type:
    Value:
    Estimation Comments The Stratified Hazard Ratio estimates and corresponding 95% CI were obtained from the number of observed and expected events as part of the stratified log-rank test calculations.
    9. Secondary Outcome
    Title Change From Baseline to 24 Months Endpoint in Height
    Description
    Time Frame Baseline, 24 Months

    Outcome Measure Data

    Analysis Population Description
    Full analysis set: all participants who received at least one dose of study drug and had evaluable data.
    Arm/Group Title Teriparatide Risedronate
    Arm/Group Description Teriparatide 20 microgram administered by subcutaneous injection once daily for 24 months. Placebo given orally once weekly for 24 months. Risedronate 35 milligram administered orally once weekly for 24 months. Placebo given by SC injection once daily for 24 months.
    Measure Participants 565 580
    Baseline
    154.7
    (7.15)
    155.0
    (7.40)
    24 Months
    154.3
    (7.05)
    154.5
    (7.42)
    Statistical Analysis 1
    Statistical Analysis Overview Comparison Group Selection Teriparatide, Risedronate
    Comments
    Type of Statistical Test Superiority
    Comments
    Statistical Test of Hypothesis p-Value 0.093
    Comments Model included the following fixed effects: treatment, visit, treatment-by-visit interaction, antecedent of recent clinical vertebral fractures, recent use of bisphosphonate and baseline body height(cm).
    Method Mixed Models Analysis
    Comments An unstructured covariance matrix was assumed to account for the correlation between observations of the same participant.
    Method of Estimation Estimation Parameter Least Squares Mean
    Estimated Value -0.13
    Confidence Interval (2-Sided) 95%
    -0.28 to 0.02
    Parameter Dispersion Type: Standard Error of the Mean
    Value: 0.08
    Estimation Comments Treatment difference was calculated as Teriparatide - Risedronate.
    10. Secondary Outcome
    Title Change From Baseline to 24 Months Endpoint in Back Pain Using an 11-point Numerical Pain Rating Scale
    Description Participants rated the worst back pain during the 24 hours preceding the visit at baseline and each post-baseline visit. An 11-point numerical back pain rating scale (rated from 0 = no back pain to 10 = worst possible back pain) was used.
    Time Frame Baseline, 24 Months

    Outcome Measure Data

    Analysis Population Description
    Full analysis set: all participants who received at least one dose of study drug and had evaluable data.
    Arm/Group Title Teriparatide Risedronate
    Arm/Group Description Teriparatide 20 microgram administered by subcutaneous injection once daily for 24 months. Placebo given orally once weekly for 24 months. Risedronate 35 milligram administered orally once weekly for 24 months. Placebo given by SC injection once daily for 24 months.
    Measure Participants 642 648
    Baseline
    4.5
    (2.90)
    4.5
    (2.91)
    24 Months
    3.4
    (2.95)
    3.4
    (2.89)
    Statistical Analysis 1
    Statistical Analysis Overview Comparison Group Selection Teriparatide, Risedronate
    Comments
    Type of Statistical Test Superiority
    Comments
    Statistical Test of Hypothesis p-Value 0.585
    Comments Model included the following fixed effects: treatment, visit, treatment-by-visit interaction, antecedent of recent clinical vertebral fractures, recent use of bisphosphonate and baseline back pain (no pain - worst pain [0-10]).
    Method Mixed Models Analysis
    Comments An unstructured covariance matrix was assumed to account for the correlation between observations of the same participant.
    Method of Estimation Estimation Parameter Least Squares Mean
    Estimated Value -0.09
    Confidence Interval (2-Sided) 95%
    -0.42 to 0.24
    Parameter Dispersion Type: Standard Error of the Mean
    Value: 0.17
    Estimation Comments Treatment difference was calculated as Teriparatide - Risedronate.
    11. Secondary Outcome
    Title Change From Baseline to 24 Months Endpoint in the European Quality of Life Questionnaire [EQ-5D-5L] (UK)
    Description The EQ-5D-5L is a generic, multidimensional, health-related, quality-of-life instrument completed on five dimensions to measure health-related quality of life. The profile allowed participants to rate their health state in five health domains: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression using a five level scale (no problems, slight problems, moderate problems, severe problems, and unable to/extreme problems). The responses are used to derive the health state index scores using the United Kingdom (UK) algorithm, with scores ranging from -0.59 to 1.0. A higher score indicates better health state.
    Time Frame Baseline, 24 Months

    Outcome Measure Data

    Analysis Population Description
    Full analysis set: all participants who received at least one dose of study drug and had evaluable data.
    Arm/Group Title Teriparatide Risedronate
    Arm/Group Description Teriparatide 20 microgram administered by subcutaneous injection once daily for 24 months. Placebo given orally once weekly for 24 months. Risedronate 35 milligram administered orally once weekly for 24 months. Placebo given by SC injection once daily for 24 months.
    Measure Participants 642 647
    Baseline
    0.59
    (0.243)
    0.62
    (0.228)
    24 Months
    0.65
    (0.249)
    0.68
    (0.205)
    Statistical Analysis 1
    Statistical Analysis Overview Comparison Group Selection Teriparatide, Risedronate
    Comments
    Type of Statistical Test Superiority
    Comments
    Statistical Test of Hypothesis p-Value 0.757
    Comments Model included the following fixed effects: treatment, visit, treatment-by-visit interaction, antecedent of recent clinical vertebral fractures, recent use of bisphosphonate baseline EQ-5D-5L (UK).
    Method Mixed Models Analysis
    Comments An unstructured covariance matrix was assumed to account for the correlation between observations of the same participant.
    Method of Estimation Estimation Parameter Least Squares Mean
    Estimated Value -0.00
    Confidence Interval (2-Sided) 95%
    -0.03 to 0.02
    Parameter Dispersion Type: Standard Error of the Mean
    Value: 0.01
    Estimation Comments Treatment difference was calculated as Teriparatide - Risedronate.
    12. Secondary Outcome
    Title Change From Baseline to 24 Months Endpoint in the European Quality of Life Questionnaire [EQ-5D-5L] (US)
    Description The EQ-5D-5L is a generic, multidimensional, health-related, quality-of-life instrument completed on five dimensions to measure health-related quality of life. The profile allowed participants to rate their health state in five health domains: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression using a five level scale (no problems, slight problems, moderate problems, severe problems, and unable to/extreme problems). The responses are used to derive the health state index scores using the United States (US) cross walk algorithm, with scores ranging from -0.11 to 1.0. A higher score indicates better health state.
    Time Frame Baseline, 24 Months

    Outcome Measure Data

    Analysis Population Description
    Full analysis set: all participants who received at least one dose of study drug and had evaluable data.
    Arm/Group Title Teriparatide Risedronate
    Arm/Group Description Teriparatide 20 microgram administered by subcutaneous injection once daily for 24 months. Placebo given orally once weekly for 24 months. Risedronate 35 milligram administered orally once weekly for 24 months. Placebo given by SC injection once daily for 24 months.
    Measure Participants 642 647
    Baseline
    0.70
    (0.167)
    0.72
    (0.159)
    24 Months
    0.74
    (0.176)
    0.76
    (0.145)
    Statistical Analysis 1
    Statistical Analysis Overview Comparison Group Selection Teriparatide, Risedronate
    Comments
    Type of Statistical Test Superiority
    Comments
    Statistical Test of Hypothesis p-Value 0.694
    Comments Model included the following fixed effects: treatment, visit, treatment-by-visit interaction, antecedent of recent clinical vertebral fractures, recent use of bisphosphonate baseline EQ-5D-5L (US).
    Method Mixed Models Analysis
    Comments An unstructured covariance matrix was assumed to account for the correlation between observations of the same participant.
    Method of Estimation Estimation Parameter Least Squares Mean
    Estimated Value -0.00
    Confidence Interval (2-Sided) 95%
    -0.02 to 0.01
    Parameter Dispersion Type: Standard Error of the Mean
    Value: 0.01
    Estimation Comments Treatment difference was calculated as Teriparatide - Risedronate.

    Adverse Events

    Time Frame
    Adverse Event Reporting Description
    Arm/Group Title Teriparatide Risedronate
    Arm/Group Description Teriparatide 20 microgram administered by subcutaneous injection once daily for 24 months. Placebo given orally once weekly for 24 months. Risedronate 35 milligram administered orally once weekly for 24 months. Placebo given by SC injection once daily for 24 months.
    All Cause Mortality
    Teriparatide Risedronate
    Affected / at Risk (%) # Events Affected / at Risk (%) # Events
    Total / (NaN) / (NaN)
    Serious Adverse Events
    Teriparatide Risedronate
    Affected / at Risk (%) # Events Affected / at Risk (%) # Events
    Total 138/683 (20.2%) 117/683 (17.1%)
    Blood and lymphatic system disorders
    Coagulopathy 1/683 (0.1%) 1 0/683 (0%) 0
    Haemolytic anaemia 0/683 (0%) 0 1/683 (0.1%) 2
    Immune thrombocytopenic purpura 1/683 (0.1%) 1 0/683 (0%) 0
    Microcytic anaemia 0/683 (0%) 0 1/683 (0.1%) 1
    Pernicious anaemia 1/683 (0.1%) 1 0/683 (0%) 0
    Thrombocytopenia 2/683 (0.3%) 2 0/683 (0%) 0
    Cardiac disorders
    Acute myocardial infarction 3/683 (0.4%) 3 1/683 (0.1%) 1
    Angina pectoris 0/683 (0%) 0 1/683 (0.1%) 1
    Atrial fibrillation 5/683 (0.7%) 5 3/683 (0.4%) 3
    Atrioventricular block 0/683 (0%) 0 1/683 (0.1%) 1
    Atrioventricular block complete 0/683 (0%) 0 2/683 (0.3%) 2
    Cardiac arrest 1/683 (0.1%) 1 0/683 (0%) 0
    Cardiac failure 2/683 (0.3%) 2 2/683 (0.3%) 2
    Cardiac failure congestive 0/683 (0%) 0 1/683 (0.1%) 1
    Cardiac valve disease 1/683 (0.1%) 1 0/683 (0%) 0
    Coronary artery disease 0/683 (0%) 0 1/683 (0.1%) 1
    Mitral valve incompetence 1/683 (0.1%) 1 1/683 (0.1%) 1
    Myocardial infarction 2/683 (0.3%) 2 1/683 (0.1%) 1
    Pericarditis 1/683 (0.1%) 1 0/683 (0%) 0
    Supraventricular tachycardia 0/683 (0%) 0 1/683 (0.1%) 1
    Tricuspid valve incompetence 1/683 (0.1%) 1 0/683 (0%) 0
    Congenital, familial and genetic disorders
    Left ventricle outflow tract obstruction 0/683 (0%) 0 1/683 (0.1%) 1
    Endocrine disorders
    Goitre 0/683 (0%) 0 1/683 (0.1%) 1
    Eye disorders
    Cataract 0/683 (0%) 0 3/683 (0.4%) 3
    Gastrointestinal disorders
    Abdominal pain 1/683 (0.1%) 1 0/683 (0%) 0
    Diverticulum 1/683 (0.1%) 1 0/683 (0%) 0
    Diverticulum intestinal 0/683 (0%) 0 1/683 (0.1%) 1
    Duodenitis 0/683 (0%) 0 1/683 (0.1%) 1
    Dysphagia 1/683 (0.1%) 1 0/683 (0%) 0
    Enteritis 2/683 (0.3%) 2 0/683 (0%) 0
    Enterocolitis 1/683 (0.1%) 1 0/683 (0%) 0
    Femoral hernia, obstructive 0/683 (0%) 0 1/683 (0.1%) 1
    Gastritis erosive 1/683 (0.1%) 1 0/683 (0%) 0
    Haemorrhoidal haemorrhage 1/683 (0.1%) 1 0/683 (0%) 0
    Hiatus hernia 0/683 (0%) 0 1/683 (0.1%) 1
    Ileus 1/683 (0.1%) 1 1/683 (0.1%) 1
    Intestinal obstruction 0/683 (0%) 0 1/683 (0.1%) 1
    Large intestine polyp 0/683 (0%) 0 1/683 (0.1%) 1
    Nausea 1/683 (0.1%) 1 0/683 (0%) 0
    Oesophageal achalasia 1/683 (0.1%) 1 0/683 (0%) 0
    Pancreatic cyst 1/683 (0.1%) 1 0/683 (0%) 0
    Pancreatitis acute 1/683 (0.1%) 1 1/683 (0.1%) 1
    Regurgitation 1/683 (0.1%) 1 0/683 (0%) 0
    Small intestinal obstruction 1/683 (0.1%) 1 0/683 (0%) 0
    Umbilical hernia 0/683 (0%) 0 1/683 (0.1%) 1
    General disorders
    Asthenia 1/683 (0.1%) 1 0/683 (0%) 0
    Death 0/683 (0%) 0 1/683 (0.1%) 1
    Oedema peripheral 1/683 (0.1%) 2 0/683 (0%) 0
    Performance status decreased 1/683 (0.1%) 1 0/683 (0%) 0
    Sudden cardiac death 0/683 (0%) 0 1/683 (0.1%) 1
    Hepatobiliary disorders
    Biliary colic 1/683 (0.1%) 1 0/683 (0%) 0
    Cholecystitis acute 0/683 (0%) 0 2/683 (0.3%) 2
    Ischaemic hepatitis 0/683 (0%) 0 1/683 (0.1%) 1
    Infections and infestations
    Abdominal sepsis 1/683 (0.1%) 1 0/683 (0%) 0
    Appendicitis 3/683 (0.4%) 3 0/683 (0%) 0
    Cellulitis 1/683 (0.1%) 1 0/683 (0%) 0
    Clostridium difficile infection 1/683 (0.1%) 1 0/683 (0%) 0
    Diverticulitis 1/683 (0.1%) 1 0/683 (0%) 0
    Erysipelas 0/683 (0%) 0 1/683 (0.1%) 1
    Escherichia pyelonephritis 0/683 (0%) 0 1/683 (0.1%) 1
    Gastroenteritis 2/683 (0.3%) 2 3/683 (0.4%) 3
    Gastroenteritis viral 1/683 (0.1%) 1 0/683 (0%) 0
    Gastrointestinal infection 0/683 (0%) 0 1/683 (0.1%) 1
    Lower respiratory tract infection 1/683 (0.1%) 1 0/683 (0%) 0
    Peritonitis 1/683 (0.1%) 1 0/683 (0%) 0
    Pneumonia 3/683 (0.4%) 3 3/683 (0.4%) 3
    Postoperative wound infection 1/683 (0.1%) 1 0/683 (0%) 0
    Pyelonephritis acute 1/683 (0.1%) 1 0/683 (0%) 0
    Pyonephrosis 0/683 (0%) 0 1/683 (0.1%) 1
    Sepsis 1/683 (0.1%) 1 1/683 (0.1%) 1
    Urinary tract infection 2/683 (0.3%) 3 1/683 (0.1%) 1
    Injury, poisoning and procedural complications
    Ankle fracture 1/683 (0.1%) 1 0/683 (0%) 0
    Cervical vertebral fracture 1/683 (0.1%) 1 0/683 (0%) 0
    Clavicle fracture 1/683 (0.1%) 1 0/683 (0%) 0
    Concussion 1/683 (0.1%) 1 0/683 (0%) 0
    Contusion 0/683 (0%) 0 2/683 (0.3%) 2
    Craniocerebral injury 2/683 (0.3%) 2 1/683 (0.1%) 1
    Fall 15/683 (2.2%) 16 19/683 (2.8%) 21
    Femoral neck fracture 4/683 (0.6%) 4 3/683 (0.4%) 3
    Femur fracture 3/683 (0.4%) 4 6/683 (0.9%) 7
    Fibula fracture 0/683 (0%) 0 2/683 (0.3%) 2
    Foot fracture 1/683 (0.1%) 1 1/683 (0.1%) 1
    Forearm fracture 0/683 (0%) 0 1/683 (0.1%) 1
    Hand fracture 1/683 (0.1%) 1 0/683 (0%) 0
    Hip fracture 1/683 (0.1%) 1 5/683 (0.7%) 5
    Humerus fracture 3/683 (0.4%) 3 5/683 (0.7%) 5
    Incisional hernia 0/683 (0%) 0 1/683 (0.1%) 1
    Injury 0/683 (0%) 0 1/683 (0.1%) 1
    Lumbar vertebral fracture 3/683 (0.4%) 4 6/683 (0.9%) 6
    Meniscus injury 0/683 (0%) 0 1/683 (0.1%) 1
    Multiple injuries 1/683 (0.1%) 1 0/683 (0%) 0
    Overdose 0/683 (0%) 0 1/683 (0.1%) 1
    Patella fracture 0/683 (0%) 0 1/683 (0.1%) 1
    Pelvic fracture 0/683 (0%) 0 3/683 (0.4%) 3
    Post procedural stroke 1/683 (0.1%) 1 0/683 (0%) 0
    Procedural nausea 1/683 (0.1%) 1 0/683 (0%) 0
    Procedural vomiting 1/683 (0.1%) 1 0/683 (0%) 0
    Radius fracture 2/683 (0.3%) 2 2/683 (0.3%) 2
    Rib fracture 3/683 (0.4%) 4 1/683 (0.1%) 3
    Scapula fracture 0/683 (0%) 0 1/683 (0.1%) 1
    Spinal compression fracture 0/683 (0%) 0 1/683 (0.1%) 1
    Spinal fracture 0/683 (0%) 0 2/683 (0.3%) 2
    Subcutaneous haematoma 1/683 (0.1%) 1 0/683 (0%) 0
    Subdural haematoma 1/683 (0.1%) 1 0/683 (0%) 0
    Tendon rupture 1/683 (0.1%) 1 0/683 (0%) 0
    Thoracic vertebral fracture 2/683 (0.3%) 6 3/683 (0.4%) 4
    Tibia fracture 0/683 (0%) 0 1/683 (0.1%) 1
    Ulna fracture 1/683 (0.1%) 1 3/683 (0.4%) 3
    Upper limb fracture 1/683 (0.1%) 1 0/683 (0%) 0
    Wrist fracture 1/683 (0.1%) 1 1/683 (0.1%) 1
    Investigations
    Blood pressure increased 1/683 (0.1%) 1 0/683 (0%) 0
    Carbohydrate antigen 19-9 increased 0/683 (0%) 0 1/683 (0.1%) 1
    General physical condition abnormal 0/683 (0%) 0 1/683 (0.1%) 1
    Weight decreased 1/683 (0.1%) 1 0/683 (0%) 0
    Metabolism and nutrition disorders
    Decreased appetite 1/683 (0.1%) 1 0/683 (0%) 0
    Dehydration 1/683 (0.1%) 1 0/683 (0%) 0
    Hyperlipidaemia 0/683 (0%) 0 1/683 (0.1%) 1
    Hypoglycaemia 1/683 (0.1%) 1 0/683 (0%) 0
    Hypokalaemia 0/683 (0%) 0 1/683 (0.1%) 1
    Hyponatraemia 0/683 (0%) 0 2/683 (0.3%) 2
    Musculoskeletal and connective tissue disorders
    Back pain 3/683 (0.4%) 3 5/683 (0.7%) 5
    Kyphosis 0/683 (0%) 0 1/683 (0.1%) 1
    Lumbar spinal stenosis 0/683 (0%) 0 1/683 (0.1%) 1
    Osteitis 1/683 (0.1%) 1 0/683 (0%) 0
    Osteoarthritis 3/683 (0.4%) 3 4/683 (0.6%) 4
    Osteonecrosis 0/683 (0%) 0 1/683 (0.1%) 1
    Periostitis 1/683 (0.1%) 1 0/683 (0%) 0
    Pseudarthrosis 1/683 (0.1%) 1 1/683 (0.1%) 1
    Rheumatoid arthritis 1/683 (0.1%) 1 1/683 (0.1%) 1
    Rotator cuff syndrome 2/683 (0.3%) 2 0/683 (0%) 0
    Spinal column stenosis 1/683 (0.1%) 1 0/683 (0%) 0
    Synovial cyst 1/683 (0.1%) 1 0/683 (0%) 0
    Tendon disorder 0/683 (0%) 0 1/683 (0.1%) 1
    Vertebral foraminal stenosis 0/683 (0%) 0 1/683 (0.1%) 1
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Acute myeloid leukaemia 1/683 (0.1%) 1 0/683 (0%) 0
    Basal cell carcinoma 1/683 (0.1%) 1 2/683 (0.3%) 2
    Bladder cancer 1/683 (0.1%) 1 0/683 (0%) 0
    Breast cancer 3/683 (0.4%) 3 0/683 (0%) 0
    Breast cancer metastatic 1/683 (0.1%) 1 0/683 (0%) 0
    Breast neoplasm 1/683 (0.1%) 1 0/683 (0%) 0
    Cervix carcinoma 1/683 (0.1%) 1 0/683 (0%) 0
    Chondrosarcoma 1/683 (0.1%) 1 0/683 (0%) 0
    Cystadenocarcinoma ovary 0/683 (0%) 0 1/683 (0.1%) 1
    Endometrial cancer 1/683 (0.1%) 1 0/683 (0%) 0
    Hypergammaglobulinaemia benign monoclonal 0/683 (0%) 0 1/683 (0.1%) 1
    Invasive breast carcinoma 1/683 (0.1%) 1 0/683 (0%) 0
    Invasive ductal breast carcinoma 1/683 (0.1%) 1 1/683 (0.1%) 1
    Laryngeal cancer 1/683 (0.1%) 1 0/683 (0%) 0
    Lung neoplasm 0/683 (0%) 0 1/683 (0.1%) 1
    Lung neoplasm malignant 1/683 (0.1%) 1 0/683 (0%) 0
    Metastases to bone 2/683 (0.3%) 2 0/683 (0%) 0
    Non-small cell lung cancer 1/683 (0.1%) 1 0/683 (0%) 0
    Ovarian cancer 1/683 (0.1%) 1 0/683 (0%) 0
    Pancreatic carcinoma metastatic 0/683 (0%) 0 1/683 (0.1%) 1
    Papillary thyroid cancer 0/683 (0%) 0 1/683 (0.1%) 1
    Plasma cell myeloma 1/683 (0.1%) 1 2/683 (0.3%) 2
    Squamous cell carcinoma 0/683 (0%) 0 1/683 (0.1%) 1
    Squamous cell carcinoma of skin 0/683 (0%) 0 1/683 (0.1%) 1
    Nervous system disorders
    Carotid artery stenosis 1/683 (0.1%) 1 0/683 (0%) 0
    Cerebellar ischaemia 0/683 (0%) 0 1/683 (0.1%) 1
    Cerebral artery embolism 0/683 (0%) 0 1/683 (0.1%) 1
    Cerebrovascular accident 2/683 (0.3%) 2 1/683 (0.1%) 1
    Depressed level of consciousness 1/683 (0.1%) 1 0/683 (0%) 0
    Embolic stroke 1/683 (0.1%) 1 0/683 (0%) 0
    Epilepsy 0/683 (0%) 0 1/683 (0.1%) 1
    Hemiparesis 0/683 (0%) 0 1/683 (0.1%) 1
    Intercostal neuralgia 1/683 (0.1%) 1 0/683 (0%) 0
    Ischaemic stroke 2/683 (0.3%) 2 3/683 (0.4%) 3
    Multiple sclerosis 0/683 (0%) 0 1/683 (0.1%) 1
    Presyncope 0/683 (0%) 0 1/683 (0.1%) 1
    Radicular pain 1/683 (0.1%) 1 1/683 (0.1%) 1
    Radiculopathy 1/683 (0.1%) 1 0/683 (0%) 0
    Sciatica 2/683 (0.3%) 2 0/683 (0%) 0
    Spinal cord compression 1/683 (0.1%) 1 0/683 (0%) 0
    Syncope 3/683 (0.4%) 3 2/683 (0.3%) 2
    Transient ischaemic attack 2/683 (0.3%) 2 2/683 (0.3%) 2
    Tremor 1/683 (0.1%) 1 0/683 (0%) 0
    Vascular dementia 1/683 (0.1%) 1 0/683 (0%) 0
    Vascular encephalopathy 1/683 (0.1%) 1 0/683 (0%) 0
    Product Issues
    Device dislocation 1/683 (0.1%) 1 0/683 (0%) 0
    Device malfunction 0/683 (0%) 0 1/683 (0.1%) 1
    Psychiatric disorders
    Alcohol abuse 1/683 (0.1%) 1 0/683 (0%) 0
    Anxiety 0/683 (0%) 0 1/683 (0.1%) 1
    Confusional state 1/683 (0.1%) 1 1/683 (0.1%) 1
    Delirium 1/683 (0.1%) 1 0/683 (0%) 0
    Major depression 1/683 (0.1%) 1 0/683 (0%) 0
    Renal and urinary disorders
    Acute kidney injury 2/683 (0.3%) 2 1/683 (0.1%) 1
    Calculus urinary 1/683 (0.1%) 1 0/683 (0%) 0
    Hydronephrosis 0/683 (0%) 0 2/683 (0.3%) 2
    Nephrotic syndrome 0/683 (0%) 0 1/683 (0.1%) 1
    Renal failure 0/683 (0%) 0 1/683 (0.1%) 1
    Renal impairment 1/683 (0.1%) 1 0/683 (0%) 0
    Ureterolithiasis 0/683 (0%) 0 1/683 (0.1%) 1
    Reproductive system and breast disorders
    Female genital tract fistula 1/683 (0.1%) 1 0/683 (0%) 0
    Ovarian cyst 0/683 (0%) 0 1/683 (0.1%) 1
    Uterine prolapse 1/683 (0.1%) 1 1/683 (0.1%) 1
    Respiratory, thoracic and mediastinal disorders
    Acute pulmonary oedema 1/683 (0.1%) 1 2/683 (0.3%) 2
    Asthma 1/683 (0.1%) 1 2/683 (0.3%) 2
    Chronic obstructive pulmonary disease 2/683 (0.3%) 2 1/683 (0.1%) 1
    Chronic respiratory failure 0/683 (0%) 0 1/683 (0.1%) 1
    Dyspnoea 0/683 (0%) 0 1/683 (0.1%) 1
    Haemothorax 1/683 (0.1%) 1 0/683 (0%) 0
    Laryngospasm 1/683 (0.1%) 1 0/683 (0%) 0
    Lung disorder 1/683 (0.1%) 1 1/683 (0.1%) 1
    Pleural effusion 3/683 (0.4%) 3 1/683 (0.1%) 1
    Pleurisy 0/683 (0%) 0 1/683 (0.1%) 1
    Pulmonary embolism 2/683 (0.3%) 2 1/683 (0.1%) 1
    Respiratory failure 1/683 (0.1%) 1 0/683 (0%) 0
    Skin and subcutaneous tissue disorders
    Skin ulcer 1/683 (0.1%) 1 0/683 (0%) 0
    Systemic lupus erythematosus rash 1/683 (0.1%) 1 0/683 (0%) 0
    Vascular disorders
    Aortic aneurysm 1/683 (0.1%) 1 0/683 (0%) 0
    Aortic stenosis 1/683 (0.1%) 1 0/683 (0%) 0
    Arterial disorder 1/683 (0.1%) 1 0/683 (0%) 0
    Deep vein thrombosis 2/683 (0.3%) 2 3/683 (0.4%) 3
    Granulomatosis with polyangiitis 1/683 (0.1%) 1 0/683 (0%) 0
    Hypertension 1/683 (0.1%) 1 2/683 (0.3%) 2
    Hypertensive crisis 0/683 (0%) 0 2/683 (0.3%) 2
    Hypotension 0/683 (0%) 0 1/683 (0.1%) 1
    Hypovolaemic shock 0/683 (0%) 0 1/683 (0.1%) 1
    Peripheral arterial occlusive disease 4/683 (0.6%) 4 0/683 (0%) 0
    Peripheral artery occlusion 1/683 (0.1%) 1 0/683 (0%) 0
    Subclavian artery occlusion 0/683 (0%) 0 1/683 (0.1%) 1
    Vena cava thrombosis 0/683 (0%) 0 1/683 (0.1%) 1
    Other (Not Including Serious) Adverse Events
    Teriparatide Risedronate
    Affected / at Risk (%) # Events Affected / at Risk (%) # Events
    Total 130/683 (19%) 130/683 (19%)
    Musculoskeletal and connective tissue disorders
    Arthralgia 44/683 (6.4%) 54 51/683 (7.5%) 63
    Back pain 73/683 (10.7%) 77 79/683 (11.6%) 89
    Pain in extremity 37/683 (5.4%) 45 0/683 (0%) 0

    Limitations/Caveats

    [Not Specified]

    More Information

    Certain Agreements

    Principal Investigators are NOT employed by the organization sponsoring the study.

    The only disclosure restriction on the PI is that the sponsor can review results communications prior to public release and can embargo communications regarding trial results for a period that is more than 60 days but less than or equal to 180 days. The sponsor cannot require changes to the communication and cannot extend the embargo.

    Results Point of Contact

    Name/Title Chief Medical Officer
    Organization Eli Lilly and Company
    Phone 800-545-5979
    Email
    Responsible Party:
    Eli Lilly and Company
    ClinicalTrials.gov Identifier:
    NCT01709110
    Other Study ID Numbers:
    • 14536
    • B3D-EW-GHDW
    • 2012-000123-41
    First Posted:
    Oct 17, 2012
    Last Update Posted:
    Sep 23, 2019
    Last Verified:
    Sep 1, 2019