Teriparatide Plus Zoledronic Acid for Osteogenesis Imperfecta: A Randomized Clinical Trial

# Teriparatide Plus Zoledronic Acid for Osteogenesis Imperfecta: A Randomized Clinical Trial *Published: 2026 May 14* reported receiving personal fees from Mereo BioPharma outside the submitted work. Dr Poole reported receiving lecture fees from UCB Pharma on behalf of Cambridge Enterprise and nonfinancial support from the NIHR Biomedical Research Centre. Dr Langdahl reported serving on the advisory boards of UCB Pharma, Mereo Biopharma, Samsung-Bioepis, Gedeon-Richter, Angitia, and EnteraBio; receiving lecture fees from UCB Pharma, Amgen, Gedeon-Richter, Samsung-Bioepis, and Gedeon-Ricther; and serving as a board member of the Danish Osteoporosis Society outside the submitted work. Dr Ghouri reported receiving honoraria and travel support from Abbott, Boehringer Ingelheim, and Menarini outside the submitted work. Dr Hollick reported receiving nonfinancial travel support from Fresenius Kabi and speaker fees from CSL Vifor outside the submitted work. Dr Crowley reported receiving support from Kyowa Kirin for attending a study meeting in 2025; consulting fees from Kyowa Kirin; and support from multiple companies for the Rare Disease Clinical Trial Network Conference outside the submitted work. Dr Hassan-Smith reported receiving personal fees from Ascendis Pharma, UCB Pharma, Alexion, and Kyowa Kirin outside the submitted work; and serving on the corporate liaison committee of the of the Society for Endocrinology and as a clinical advisor to the Royal Osteoporosis Society. Dr Curtis reported receiving personal fees from UCB Pharma, Thornton and Ross, Eli Lilly, and Pfizer outside the submitted work. Dr Harvey reported receiving consultancy fees and honoraria for serving on advisory boards of Amgen, UCB Pharma, EchoLight, Kyowa Kirin, and Theramex. Dr Eekhoff reported receiving partial reimbursement for the costs of the trial from the University of Edinburgh during the conduct of the study; reimbursement from Regeneron and Incyte to his university for the costs of the trial and research; grants from EU-IMI in collaboration with AstraZeneca, the Dutch Fund for Rare Disease (ZZF), and the Ehler’s Danlos Association outside the submitted work. Dr Patel reported receiving research support from the University Hospitals of Leicester NHS Trust for a commercial trial, cost was reimbursed per patient recruited during the conduct of the study. Dr Roy reported receiving consultancy fees from Kyowa Kirin and Mereo BioPharma outside the submitted work. Dr Paskins reported receiving grants from the National Institute for Health and Care Research (NIHR), Versus Arthritis, the Royal Osteoporosis Society, and UCB Pharma; personal fees from UCB Pharma and the Royal College of General Practitioners, outside the submitted work; and serving as the chair of the Versus Arthritis musculoskeletal research advisory group and serving as the current chair of the Haywood Foundation Charity. Dr Javaid reported receiving grants from Kyowa Kirin, personal fees from Kyowa Kirin, UCB Pharma, Nanox-AI, Naitive Technologies, Amgen, and Regeneron outside the submitted work; and serving as chair of the Brittle Bone Society medical advisory committee and cochair of the NHS Adult Rare Bone Disease Collaborative Network. Dr Osborne reported receiving grants from the Mereo Biopharma Charity, Kyowa Kirin, and Ultragenyx outside the submitted work and serving as CEO of the Brittle Bone Society. Dr Duckworth reported receiving grants from the NIHR, Orthopaedic Trauma Association, and the Scottish Orthopaedic Research Trust into Trauma (SORT-iT); unrelated institutional educational and research grants from Smith & Nephew, Acumed, and Stryker; book royalties from Taylor & Francis and Elsevier; and personal fees for educational elbow courses from Swemac, Medartis, and Smith & Nephew. Dr Ralston reported submitting a patent application concerning the use of teriparatide plus zoledronic acid as a treatment for pain in osteogenesis imperfecta; receiving grants from the Royal Osteoporosis Society, Angitia, the European Research Council, and the Brittle Bone Society; consulting fees from Kyowa Kirin, Relation Therapeutics, and UCB Pharma; serving on the boards of the SORT-IT charity, Paget’s Association, Pregnancy Associated Osteoporosis UK, and the Brittle Bone Society outside the submitted work. No other disclosures were reported. 33. JAMA. 2026 May 13:e265663. doi: 10.1001/jama.2026.5663. Online ahead of print. Pragmatic Parental Support to Mitigate Burnout Among Pregnant and Postpartum Trainees: A Randomized Clinical Trial. Rubio-Chavez A(1)(2), Koelliker EL(1), Askew EA(1), Shanafelt TD(3), Landrigan CP(4), Winn AS(4), Farid H(5), Lillemoe KD(1), Agarwal D(1), Locascio JJ(6), Lwin TM(7), Rangel EL(1). Author information: (1)Department of Surgery, Massachusetts General Hospital, Boston. (2)Department of Surgery, Tufts Medical Center, Boston, Massachusetts. (3)Department of Medicine, Stanford University School of Medicine, Stanford, California. (4)Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts. (5)Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts. (6)Harvard Catalyst Biostatistical Consulting Group, Massachusetts General Hospital, Boston. (7)Department of Surgical Oncology, City of Hope National Medical Center, Duarte, California. Comment in doi: 10.1001/jama.2026.5799. doi: 10.1001/jama.2026.5065. Comment in doi: 10.1001/jama.2026.5844. ## IMPORTANCE Occupational burnout threatens care quality, workforce retention, and physician health. Childbearing physicians in training are at high risk due to stigma, low workplace support, and physical challenges compounding role transitions and increased home responsibilities, yet evaluations of mitigation strategies remain scarce. ## OBJECTIVE To assess the efficacy of a parental support package targeting perinatal stressors in reducing burnout and distress among childbearing physicians in training. DESIGN, SETTING, AND PARTICIPANTS Pragmatic, randomized, controlled, parallel-group clinical trial. Pregnant (≥12 weeks' gestation) residents and fellows were enrolled across 7 training institutions in the northeastern US from May 2023 to July 2024. Nonbirthing parents were excluded. Follow-up concluded in May 2025. ## INTERVENTIONS Participants were randomized 1:1, stratified by site and specialty type (procedural vs nonprocedural), to receive a parental support package (n = 78) or usual support (n = 78) from early pregnancy through 24 weeks post partum. The parental support package included a smart bassinet, wearable breast pump, virtual perinatal support, and formal faculty mentorship. MAIN OUTCOMES AND MEASURES The primary outcome was change in burnout (Stanford Professional Fulfillment Index; score range, 0-10; and the emotional exhaustion and interpersonal disengagement subscales), from enrollment during pregnancy to 24 weeks post partum. Secondary outcomes included changes in professional fulfillment, organizational and personal values alignment, relationship strain, career dissatisfaction, and sleep-related impairment. Mixed-effects models analyzed outcomes. Effect sizes were standardized using the Cohen d (0.2: small; 0.5: medium; 0.8: large). ## RESULTS Of 156 randomized participants, 143 were included in the primary analysis (median age, 32 [IQR, 31-34] years; 71 in the parental support package group and 72 in the usual support group). From enrollment during pregnancy to 24 weeks post partum, mean burnout scores increased from 2.96 to 3.03 in the parental support package group and from 3.13 to 3.79 in the usual support group (adjusted between-group difference in change, -0.58; 95% CI, -1.10 to -0.07; P = .03; d = 0.65). Differences were driven by interpersonal disengagement (adjusted between-group difference in change, -0.70; 95% CI, -1.24 to -0.15; P = .01; d = 0.57). Emotional exhaustion scores were not statistically different between groups. CONCLUSIONS AND RELEVANCE Among childbearing physicians in training, a parental support package significantly mitigated postpartum burnout. ## TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT06014892. DOI: 10.1001/jama.2026.5663 PMCID: PMC13173429 DOI: 10.1001/jama.2026.6889