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Meta-Analysis
. 2023 Jun 22;18(1):447.
doi: 10.1186/s13018-023-03920-4.

Clinical efficacy of denosumab, teriparatide, and oral bisphosphonates in the prevention of glucocorticoid-induced osteoporosis: a systematic review and meta-analysis

Chuanjian Yuan  1 , Yanchen Liang  2 , Kai Zhu  1 , Wenpeng Xie  3
Affiliations
Meta-Analysis

Clinical efficacy of denosumab, teriparatide, and oral bisphosphonates in the prevention of glucocorticoid-induced osteoporosis: a systematic review and meta-analysis

Chuanjian Yuan et al. J Orthop Surg Res. .

Abstract

Background: Continuous use of glucocorticoids (GCs) has become the primary cause of secondary osteoporosis. Bisphosphonate drugs were given priority over denosumab and teriparatide in the 2017 American College of Rheumatology (ACR) guidelines but have a series of shortcomings. This study aims to explore the efficacy and safety of teriparatide and denosumab compared with those of oral bisphosphonate drugs.

Methods: We systematically searched studies included in the PubMed, Web of Science, Embase, and Cochrane library databases and included randomized controlled trials that compared denosumab or teriparatide with oral bisphosphonates. Risk estimates were pooled using both fixed and random effects models.

Results: We included 10 studies involving 2923 patients who received GCs for meta-analysis, including two drug base analyses and four sensitivity analyses. Teriparatide and denosumab were superior to bisphosphonates in increasing the bone mineral density (BMD) of the lumbar vertebrae [teriparatide: mean difference [MD] 3.98%, 95% confidence interval [CI] 3.61-4.175%, P = 0.00001; denosumab: MD 2.07%, 95% CI 0.97-3.17%, P = 0.0002]. Teriparatide was superior to bisphosphonates in preventing vertebral fractures and increasing hip BMD [MD 2.39%, 95% CI 1.47-3.32, P < 0.00001]. There was no statistically significant difference between serious adverse events, adverse events, and nonvertebral fracture prevention drugs.

Conclusions: Teriparatide and denosumab exhibited similar or even superior characteristics to bisphosphonates in our study, and we believe that they have the potential to become first-line GC-induced osteoporosis treatments, especially for patients who have previously received other anti-osteoporotic drugs with poor efficacy.

Keywords: Bisphosphonates; Denosumab; Glucocorticoid; Osteoporosis; Teriparatide.

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Conflict of interest statement

The authors declared that there were no competing interests in the study.

Figures

Fig. 1
Fig. 1
Flow diagram of literature search and study inclusion
Fig. 2
Fig. 2
The risk figure of bias in the randomized trials
Fig. 3
Fig. 3
A Meta-analysis of denosumab-associated lumbar bone mineral density (BMD) change. B Meta-analysis of teriparatide-associated lumbar bone mineral density (BMD) change
Fig. 4
Fig. 4
A Meta-analysis of denosumab-associated serious adverse events. B Meta-analysis of teriparatide-associated serious adverse events
Fig. 5
Fig. 5
A Meta-analysis of denosumab-associated vertebral fractures. B Meta-analysis of teriparatide-associated vertebral fractures
Fig. 6
Fig. 6
A Meta-analysis of denosumab-associated adverse events. B Meta-analysis of teriparatide-associated adverse events
Fig. 7
Fig. 7
Meta-analysis of teriparatide-associated nonvertebral fractures
Fig. 8
Fig. 8
A Meta-analysis of denosumab-associated total hip bone mineral density (BMD) change. B Meta-analysis of teriparatide-associated total hip bone mineral density (BMD) change
See this image and copyright information in PMC

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