Head-to-head comparisons of bisphosphonates and teriparatide in osteoporosis: a meta-analysis

Abstract

Head-to-head comparisons of bisphosphonates and teriparatide in osteoporosis: a meta-analysis Abstract Purpose: This meta-analysis aimed to compare the efficacy and safety of teriparatide vs. bisphosphonates in the management of osteoporosis.Methods: A total of 1,967 patients from eight randomized controlled trials were analyzed; outcomes included bone mineral density (BMD) of the femoral neck, total hip and lumbar spine, vertebral and nonvertebral fractures and any adverse event. A subgroup analysis of treatment effectiveness was performed according to the etiology of osteoporosis; i.e., glucocorticoid-induced osteoporosis (GIO) vs. post-menopausal osteoporosis (PO).Results: Teriparatide increased the BMD of the lumbar spine, femoral neck and total hip to a greater extent than bisphosphonates. Patients treated with teriparatide also had a lower risk of vertebral fractures compared with bisphosphonates; however, no difference in risk of nonvertebral fractures (or adverse events) was found. GIO subgroups showed larger increases in BMD of the lumbar spine, total hip and femoral neck in patients treated with teriparatide compared with bisphosphonates. The PO subgroup showed larger increases in BMD of the lumbar spine in patients treated with teriparatide compared with bisphosphonates. Patients in the GIO subgroup (but not the PO subgroup) were less likely to suffer a vertebral fracture on teriparatide as compared with bisphosphonates. In contrast, no significant difference in the percentage of nonvertebral fractures was noted between the two types of treatment for either subgroup. Conclusion:Teriparatide significantly increased the BMD of lumbar spine, total hip and femoral neck, particularly in GIO-induced osteoporosis. Teriparatide did not lower the risk of nonvertebral fractures when compared with bisphosphonates.

Balancing Altered Calcium Metabolism with Bone Health in Sarcoidosis

“…The agent teriparatide may be an alternative treatment for steroid-induced bone thinning. 75,76 Because PTH stimulates the key calcium-regulating enzyme, 1α-hydroxylase, 77 care must be taken when administered to sarcoidosis patients. There is a small case series of sarcoidosis patients treated with teriparatide for severe osteoporosis.…”

Osteoanabolic and dual action drugs

“…After 18 months, patients treated with TPTD showed a greater increase in lumbar spine and femoral neck BMD compared to risedronate. Meta‐analysis comparing TPTD and bisphosphonates has shown that TPTD increased the BMD of the lumbar spine, femoral neck and total hip to a greater extent than bisphosphonates . However, no difference in risk of non‐vertebral fractures (and adverse events) was found .…”

Effect of bisphosphonates or teriparatide on mechanical complications after posterior instrumented fusion for osteoporotic vertebral fracture: a multi-center retrospective study

“…TP is a recombinant form of human parathyroid hormone and is the first osteogenic agent to enter clinical use. Improvements in lumbar bone mineral density (BMD) of 4.54-7.48% have been reported for BP, whereas 6.4% improvement of BMD was reported after 2 years of administration of TP [9]. However, because TP is expensive and the allowed duration of administration is limited, the use of TP is problematic in terms of timing [10].…”