***TASK*** the task is to summarize an input biomedical literature in six sentences 
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    Input: BACKGROUND No clinical trials have compared osteoporosis drugs with incident fractures as the primary outcome . We compared the anti-fracture efficacy of teriparatide with risedronate in patients with severe osteoporosis . METHODS In this double-blind , double-dummy trial , we enrolled post-menopausal women with at least two moderate or one severe vertebral fracture and a bone mineral density T score of less than or equal to -1·50 . Participants were r and omly assigned to receive 20 μg of teriparatide once daily plus oral weekly placebo or 35 mg of oral risedronate once weekly plus daily injections of placebo for 24 months . The primary outcome was new radiographic vertebral fractures . Secondary , gated outcomes included new and worsened radiographic vertebral fractures , clinical fractures ( a composite of non-vertebral and symptomatic vertebral ) , and non-vertebral fractures . This study is registered with Clinical Trials.gov ( NCT01709110 ) and EudraCT ( 2012 - 000123 - 41 ) . FINDINGS We enrolled 680 patients in each group . At 24 months , new vertebral fractures occurred in 28 ( 5·4 % ) of 680 patients in the teriparatide group and 64 ( 12·0 % ) of 680 patients in the risedronate group ( risk ratio 0·44 , 95 % CI 0·29 - 0·68 ; p<0·0001 ) . Clinical fractures occurred in 30 ( 4·8 % ) of 680 patients in the teriparatide group compared with 61 ( 9·8 % ) of 680 in the risedronate group ( hazard ratio 0·48 , 95 % CI 0·32 - 0·74 ; p=0·0009 ) . Non-vertebral fragility fractures occurred in 25 ( 4·0 % ) patients in the teriparatide group and 38 ( 6·1 % ) in the risedronate group ( hazard ratio 0·66 ; 95 % CI 0·39 - 1·10 ; p=0·10 ) . INTERPRETATION Among post-menopausal women with severe osteoporosis , the risk of new vertebral and clinical fractures is significantly lower in patients receiving teriparatide than in those receiving risedronate . FUNDING Lilly CONTEXT Current osteoporosis medications increase bone mineral density ( BMD ) modestly and reduce , but do not eliminate , fracture risk . Attempts to improve efficacy by administering anabolic agents and bisphosphonates concomitantly have been unsuccessful . Conversely , 12 months of concomitant denosumab and teriparatide therapy increases BMD more than either drug alone . OBJECTIVE The purpose of this study was to determine whether 24 months of combined denosumab and teriparatide will increase hip and spine BMD more than either individual agent . DESIGN Preplanned continuation of the Denosumab and Teriparatide Administration ( DATA ) r and omized controlled trial in which postmenopausal osteoporotic women received teriparatide ( 20 μg daily ) , denosumab ( 60 mg every 6 months ) , or both medications for 24 months . PARTICIPANTS Participants were 94 postmenopausal women with osteoporosis . OUTCOME MEASURES Lumbar spine , femoral neck , total hip , and distal radius BMD and serum markers of bone turnover were measured . RESULTS At 24 months , lumbar spine BMD increased more in the combination group ( 12.9 ± 5.0 % ) than in either the teriparatide ( 9.5 ± 5.9 % , P = .01 ) or denosumab ( 8.3 ± 3.4 % , P = .008 ) groups . Femoral neck BMD also increased more in the combination group ( 6.8 ± 3.6 % ) than in either the teriparatide ( 2.8 ± 3.9 % , P = .003 ) or denosumab ( 4.1 ± 3.8 % , P = .008 ) groups . Similarly , total hip BMD increased more in the combination group ( 6.3 ± 2.6 % ) than in the teriparatide ( 2.0 ± 3.0 % ) or denosumab ( 3.2 ± 2.5 % ) groups ( P < .001 for both ) . Although spine and hip BMD continued to increase in the second year in all groups , these year 2 increases did not differ among groups . Serum C-telopeptide and N-terminal propeptide of type 1 procollagen were equally suppressed in the denosumab and combination groups , whereas osteocalcin decreased more in the denosumab group than in the combination group , a difference that persisted , but lessened , in the second year of therapy . CONCLUSIONS Two years of concomitant teriparatide and denosumab therapy increases BMD more than therapy with either medication alone and more than has been reported with any current therapy . The combination of these agents may prove to be an important treatment option in patients at high risk of fracture BACKGROUND Unlike most chronic diseases , osteoporosis treatments are generally limited to a single drug at a fixed dose and frequency . Nonetheless , no approved therapy is able to restore skeletal integrity in most osteoporotic patients and the long-term use of osteoporosis drugs is controversial . Thus , many patients are treated with the sequential use of two or more therapies . The DATA study showed that combined teriparatide and denosumab increased bone mineral density more than either drug alone . Discontinuing teriparatide and denosumab , however , results in rapidly declining bone mineral density . In this DATA -Switch study , we aim ed to assess the changes in bone mineral density in postmenopausal osteoporotic women who transitioned between treatments . METHODS This r and omised controlled trial ( DATA -Switch ) is a preplanned extension of the denosumab and teriparatide administration study ( DATA ) , in which 94 postmenopausal osteoporotic women were r and omly assigned to receive 24 months of teriparatide ( 20 mg daily ) , denosumab ( 60 mg every 6 months ) , or both drugs . In DATA -Switch , women originally assigned to teriparatide received denosumab ( teriparatide to denosumab group ) , those originally assigned to denosumab received teriparatide ( denosumab to teriparatide group ) , and those originally assigned to both received an additional 24 months of denosumab alone ( combination to denosumab group ) . Bone mineral density at the spine , hip , and wrist were measured 6 months , 12 months , 18 months , and 24 months after the drug transitions as were biochemical markers of bone turnover . The primary endpoint was the percent change in posterior-anterior spine bone mineral density over 4 years . Between-group changes were assessed by one-way analysis of variance in our modified intention-to-treat population . This study is registered with Clinical Trials.gov , number NCT00926380 . FINDINGS Between Sept 27 , 2011 , and Jan 28 , 2013 , eligible women from the DATA study were enrolled into DATA -Switch . Of 83 potential enrollees from the DATA study , 77 completed at least one post-baseline visit . After 48 months , the primary outcome of mean spine bone mineral density increased by 18·3 % ( 95 % CI 14·9 - 21·8 ) in 27 women in the teriparatide to denosumab group , 14·0 % ( 10·9 - 17·2 ) in 27 women the denosumab to teriparatide group , and 16·0 % ( 14·0 - 18·0 ) in 23 women in the combination to denosumab group , although this increase did not differ significantly between groups ( for between-group comparisons , p=0·13 for the teriparatide to denosumab group vs the denosumab to teriparatide group , p=0·30 for the teriparatide to denosumab group vs the combination to denosumab group , and p=0·41 for the denosumab to teriparatide group vs the combination to denosumab  group ) . For the bone mineral density secondary outcomes , total hip bone mineral density increased more in the teriparatide to denosumab group ( 6·6 % [ 95 % CI 5·3 - 7·9 ] ) than in the denosumab to teriparatide group ( 2·8 % [ 1·3 - 4·2 ] , p=0·0002 ) , but had the greatest increase in the combination to denosumab group ( 8·6 % [ 7·1 - 10·0 ] ; p=0·0446 vs the teriparatide to denosumab group , p<0·0001 vs the denosumab to teriparatide group ) . Similarly , femoral neck bone mineral density increased more in the teriparatide to denosumab group ( 8·3 % [ 95 % CI 6·1 - 10·5 ] ) and the combination to denosumab group ( 9·1 % [ 6·1 - 12·0 ] ) than in the denosumab to teriparatide group ( 4·9 % [ 2·2 - 7·5 ] ; p=0·0447 for teriparatide to denosumab vs denosumab to teriparatide , p=0·0336 for combination to denosumab vs denosumab to teriparatide ) . Differences between the combination to denosumab group and the teriparatide to denosumab group did not differ significantly ( p=0·67 ) . After 48 months , radius bone mineral density was unchanged in the teriparatide to denosumab group ( 0·0 % [ 95 % CI -1·3 to 1·4 ] ) , whereas it decreased by -1·8 % ( -5·0 to 1·3 ) in the denosumab to teriparatide group , and increased by 2·8 % ( 1·2 - 4·4 ) in the combination to denosumab group ( p=0·0075 for the teriparatide to denosumab group vs the combination to denosumab group ; p=0·0099 for the denosumab to teriparatide group vs the combination to denosumab group ) . One participant in the denosumab to teriparatide group had nephrolithiasis , classified as being possibly related to treatment . INTERPRETATION In postmenopausal osteoporotic women switching from teriparatide to denosumab  , bone mineral density continued to increase , whereas switching from denosumab to teriparatide results in progressive or transient bone loss . These results should be considered when choosing the initial and subsequent management of postmenopausal osteoporotic patients . FUNDING Amgen , Eli Lilly , and National Institutes of Health We present final results of a study comparing teriparatide 20 μg every day ( QD ) with risedronate 35 mg once per week ( QW ) started within 2 weeks after surgery for a pertrochanteric hip fracture . Patients with BMD T-score ≤ -2.0 and 25OHD ≥9.2 ng/mL were r and omized to receive 26-week double-dummy treatment plus calcium and vitamin D , followed by 52-week open-label treatment with the same assigned active drug . Primary endpoint was change from baseline in lumbar spine ( LS ) BMD at 78 weeks . Secondary and exploratory endpoints were change in BMD at the proximal femur , function , hip pain ( Charnley score and 100 mm Visual Analog Scale [ VAS ] ) , quality of life ( Short Form-36 ) , radiology outcomes , and safety . Data were analyzed with mixed models for repeated measures ( MMRM ) and logistic regression . Totally , 224 patients were r and omized ; 171 ( teriparatide : 86 ) contributed to the efficacy analyses ( mean ± SD age : 77 ± 7.7 years , 77 % females ) . Mean baseline LS , femoral neck ( FN ) , and total hip ( TH ) T-scores were -2.16 , -2.63 , and -2.51 , respectively . At 78 weeks , BMD increased significantly more with teriparatide compared to risedronate at the LS ( + 11.08 % versus + 6.45 % ; p < 0.001 ) and FN ( + 1.96 % versus -1.19 % ; p = 0.003 ) , with no significant between-group difference in TH BMD . Timed up- and -go ( TUG ) test was significantly faster with teriparatide at 6 , 12 , 18 , and 26 weeks ( differences : -3.2 to -5.9 s ; p = 0.045 for overall difference ) . Hip pain during TUG test by 100 mm VAS was significantly lower with teriparatide at 18 weeks ( adjusted difference : -11.3 mm , p = 0.033 ; -10.0 and -9.3 mm at 12 and 26 weeks , respectively ; p = 0.079 for 
    Output:
    
This meta- analysis provides evidence of efficacy of teriparatide in reducing hip fractures by 56 % in patients with osteoporosis