Three months of abaloparatide treatment rapidly improves bone formation and density: implications for orthopedic preoperative bone health optimization

How long to delay orthopedic surgery for preoperative BHO using ABL remains unclear. MAIN FINDING: ABL results in significant BMD gains by three months in both men and postmenopausal women with osteoporosis. ABL shows promise for preoperative BHO in elective orthopedic surgery patients, but further research is required. PURPOSES: This study aims to assess the early response to abaloparatide (ABL) in men and postmenopausal women with osteoporosis at high risk for fracture to inform its potential role in preoperative bone health optimization (BHO). We aim to assess changes in bone mineral density (BMD) by three months and early changes in bone turnover markers (BTMs). METHODS: A post-hoc analysis of two randomized ABL trials in men and postmenopausal women with osteoporosis was performed. BMD and BTM data from 149 men and 250 postmenopausal treated with ABL for 12 months were assessed. The primary endpoint was mean percent BMD change at 3-months in the femoral neck, total hip, and lumbar spine. BTMs P1NP and CTX were also assessed. RESULTS: At 3 months, mean (SD) BMD percent increases in men were 1.79 (0.35), 1.26 (0.26), and 4.14 (0.43), at the femoral neck, total hip, and lumbar spine, respectively. In women, mean BMD percent increases at the same sites were 1.55 (0.28), 1.78 (0.21), and 4.42 (0.34) respectively. Compared with baseline, serum P1NP increased over threefold at 1 month in women and men. CONCLUSION: Subcutaneous ABL (80 µg/day) results in significant BMD gains by three months in both men and postmenopausal women with osteoporosis at levels associated with decreased fracture risk. Bone formation is increased at 1 month and sustained for 12 months. Further research is required to investigate the effectiveness of a three-month ABL treatment period on bone strength and osteoporosis-related surgical complications in elective orthopedic surgery patients.