# Clinical outcomes of twice-weekly teriparatide acetate administration in osteoporosis

## TL;DR

A study found that a twice-weekly teriparatide regimen improved bone density and had a moderate continuation rate in osteoporosis patients.

## Contribution

The study evaluates the efficacy and tolerability of a twice-weekly teriparatide regimen in a real-world osteoporosis treatment setting.

## Key findings

- The treatment continuation rate was 47.9% with minimal new fractures reported.
- Spine BMD increased significantly in most groups, with the highest gain in treatment-naïve patients.
- W2TPD showed effectiveness even after bisphosphonate treatment.

## Abstract

W2TPD, a twice-weekly teriparatide administration regimen, was used on 163 patients. The continuation rate was 47%, with only one new fracture. Even after performing antiresorptive therapy, spine BMD increased significantly in the majority of groups. W2TPD demonstrated good efficacy and tolerability in a real-world sequential osteoporosis treatment model.

Teriparatide is the most commonly administered daily, but there are also once-weekly and twice-weekly regimens. The former demonstrated high efficacy in increasing bone mineral density (BMD) and preventing new fractures; however, the continuation rate was reported to be low due to a high incidence of side effects. As a result, the twice-weekly teriparatide administration schedule (W2TPD) was created. In this study, we conducted a real-world clinical evaluation of its efficacy as part of a sequential osteoporosis treatment regimen.

The study included 163 patients with osteoporosis who were treated with W2TPD. Patients treated with W2TPD were divided into five groups based on their prior medication use: treatment-naïve (N), post-denosumab (post-D), post-bisphosphonate (post-B), post-romosozumab (post-R), and post-SERM (post-S). We examined treatment continuation rates, adverse events, and changes in BMD.

The overall treatment continuation rate was 47.9%, with only one patient developing a new fracture during treatment. Gastrointestinal side effects, such as heartburn, nausea, and vomiting, were common. The percent changes in spine BMD were 10%, 5.2%, 5%, − 1.5%, and 12.3% in the N, post-D, post-B, post-R, and post-S groups, respectively. Meanwhile, hips were found in 3.1%, 0.4%, 1.5%, 0%, and 2.2%, respectively. In terms of spine BMD, all groups except post-R had responder rates greater than 50%.

The continuation rate of W2TPD was 47% and resulted in particularly favorable BMD gains in the spine. It was also discovered to be effective in increasing BMD even when following bisphosphonate treatment.

The online version contains supplementary material available at 10.1007/s11657-025-01622-4.