The VERO Trial Results: Teriparatide vs Risedronate for the Treatment of Osteoporosis
Learning Objectives and CME/Disclosure Information
This activity is intended for healthcare providers delivering care to women and their families.
After completing this activity, the participant should be better able to:
1. Discuss how teriparatide and risedronate work to prevent osteoporosis 2. Recall which medication was superior in reducing risk of vertebral fractures in women with severe osteoporosis
Estimated time to complete activity: 0.25 hours
Susan J. Gross, MD, FRCSC, FACOG, FACMG
President and CEO, The ObG Project
Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) requires faculty, planners, and others in control of educational content to disclose all their financial relationships with ineligible companies. All identified conflicts of interest (COI) are thoroughly vetted and mitigated according to PIM policy. PIM is committed to providing its learners with high quality accredited continuing education activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of an ineligible company.
The PIM planners and others have nothing to disclose. The OBG Project planners and others have nothing to disclose.
Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.
Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.
Method of Participation and Request for Credit
Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from 1/31/2017 through 1/25/2023, participants must read the learning objectives and faculty disclosures and study the educational activity.
If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.
For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.
Joint Accreditation Statement
In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physician Continuing Medical Education
Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Continuing Nursing Education
The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours.
Designated for 0.1 contact hours of pharmacotherapy credit for Advance Practice Registered Nurses.
VERtebral fracture treatment comparisons in osteoporotic women (VERO) trial
123 centers in 14 countries with experience managing osteoporosis
Inclusion: Post-menopausal women with at least two moderate or one severe vertebral fracture and a bone mineral density T score ≤ -1.50 at the femoral neck, total hip, or lumbar spine
Participants were randomized 1:1 to receive for 24 months either
20 μg injectable subQ of teriparatide once daily plus oral weekly placebo
35 μg of oral risedronate once weekly plus daily injections of placebo
Primary outcome: The percentage of patients with at least one new vertebral fracture over the study period
Secondary outcomes: Incidence of pooled new and worsened vertebral fractures, the incidence of clinical fractures (a composite of clinical vertebral and non-vertebral fragility fractures), non-vertebral fragility fractures, and major non-vertebral fragility fractures
680 patients in each group started treatment
Overall mean age was 72.1 years
Primary endpoint: Incidence of new vertebral fracture
5.4% of the teriparatide group, and 12.0% of the risedronate group had new radiographic vertebral fractures at 24 months
Absolute risk reduction of 6.6% (risk ratio 0.44, 95% CI 0.29-0.68; p<0.0001)
Clinical fractures occurred in 4.8% of the teriparatide group compared to the 9.8% of risedronate group (hazard ratio (HR) 0.48, 95% CI 0.32-0.74; p=0.0009)
Difference in non-vertebral fractures was not significant, occurring in 4.0% of the teriparatide group and 6.1% of the risedronate group (HR 0.66; 95% CI 0.39-1.10; p=0.10)
There was a relative risk reduction of 56% for vertebral fractures in the teriparatide group compared to the risedronate group
Patients experienced improvement in back pain and health-related quality of life in both arms of the study
Among post-menopausal women with severe osteoporosis, risk for new vertebral and clinical fractures was significantly lower in patients receiving teriparatide compared to risedronate
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Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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