Katelyn Junghans - Department of Geriatric Medicine
With age comes the concern of osteoporosis for many women, characterized by decreased bone mineral density and increases in the risk of bone fractures. Treatment for osteoporosis continues to develop with current medications including antiabsorptive drugs and bone-forming agents. The goal of treatment is to limit the breakdown of bone tissue and increase bone density. Current recommendations suggest bone-forming agents over antiabsorptive medications. Administration of bone-forming agents such as abaloparatide commonly involves subcutaneous injections, which decreases the ability of patients to receive the medication as they can’t self-administer and can be apprehensive toward needles. Thus, a study evaluated transdermal microneedle patches to determine whether they would be a viable alternative.
A randomized control trial compared transdermal abaloparatide-sMTS 300µg to subcutaneous abaloparatide-SC 80µg, similar doses in terms of pharmacokinetics. The study included female postmenopausal participants aged between 50-85 who met qualifying measures of severe osteoporosis and measured their bone mineral density (BMD) over 12 months in their lumbar spines as the primary metric. It found that the transdermal patches do not outperform the subcutaneous injections which demonstrated a 3.72% greater increase in spine BMD (7.14% patch versus 10.86% injection) [1]. Despite not meeting the US FDA’s noninferiority measurement of 2.0%, meaning the 3.72% difference was too large to say transdermal wasn’t statistically inferior, few clinical fractures occurred in either group, though adverse events including skin aggravation were more common with transdermal.
Interestingly, more patients withdrew from the trial from the subcutaneous group than the transdermal group. Given this as well as the clinically relevant increase in bone mineral density and the low fracture rates, we don’t have to write off transdermal patches entirely. More research into the doses and continued improvements to the patch technology may lead to a future where they can outperform subcutaneous injections.
References:
Lewiecki, E. M., Czerwinski, E., Recknor, C., Strzelecka, A., Valenzuela, G., Lawrence, M., Silverman, S., Cardona, J., Nattrass, S. M., Binkley, N., Annett, M., Pearman, L., & Mitlak, B. (2023). Efficacy and Safety of Transdermal Abaloparatide in Postmenopausal Women with Osteoporosis: A Randomized Study. Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research, 38(10), 1404–1414. https://doi.org/10.1002/jbmr.4877
Edited By: Firas Batrash, Editor-in-Chief
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