This week we profile a recent publication in Lancet from the laboratory of Dr. David Kendler at the University of British Columbia.
Can you provide a brief overview of your lab’s current research focus?
Our clinical research centre has been engaged in phase 1 through phase 4 clinical research studies in the area of metabolic bone disease. These research studies have validated the efficacy and safety of treatment options for patients with osteoporosis. Most studies compare treatment to no treatment (placebo), in order to achieve regulatory agency approval. This highlighted two year VERO clinical trial compares antiresorptive (bone preserving) therapy with anabolic (bone forming) therapy with fracture as a primary endpoint. Both therapies in the study have been marketed globally for over 10 years.
What is the significance of the findings in this publication?
The VERO study is the first properly designed and powered clinical trial comparing antiresorptive with bone anabolic therapy with fracture as the primary endpoint. Although it makes intuitive sense to first build bone and then preserve improved bone strength, the cost as well as the lack of proven anti-fracture superiority has led to the underutilization of bone anabolic therapy. The VERO study confirms that, compared to antiresorber (risedronate, a bisphosphonate) bone anabolic therapy (with teriparatide) results in a 50% to 60% further reduction in clinical fractures and vertebral fractures. This should solidify in clinicians’ minds that the first choice therapy for patients with severe osteoporosis and fracture should be initial bone anabolic therapy with teriparatide followed by antiresorptive therapy.
What are the next steps for this research?
Our laboratory is involved with clinical trials involving other bone anabolics with different mechanisms of action. For example, romosozumab has been submitted for approval as a monthly subcutaneous injection for 12 months, followed by antiresorber. These studies will help us to appropriately position the different treatments which we have for patients with osteoporosis.
