Teriparatide in postmenopausal osteoporosis: uncovering novel insights into efficacy and safety compared to other treatments - a systematic review and meta-analysis

Abstract

Objective: The aim of the study was to evaluate the efficacy and safety of teriparatide compared to other treatments for postmenopausal osteoporosis.

Methods: A review of studies from 2000 to January 2023 analyzed randomized controlled trials on postmenopausal women treated with teriparatide (PTH 1-34), comparing it to placebo or other osteoporosis treatments. The analysis focused on bone mineral density (BMD), bone turnover markers, and clinical outcomes, employing Review Manager 5.4.1 and the RoB 2 tool for bias assessment.

Results: Our analysis of 23 randomized controlled trials (RCTs) found that PTH (134) treatment significantly increased lumbar spine BMD (mean difference (MD) = 0.02, 95% CI: 0.01-0.03) and femoral neck BMD (MD = 0.01, 95% CI: 0.00-0.01). However, there were no significant changes in total hip and radial bone BMD among the 3536 and 2046 participants, respectively. We also found that PTH (1-34) increased P1NP in a larger cohort (n = 1415) when compared to osteocalcin (n = 206). Although the risk of adverse events increased (relative risk (RR) = 1.65, 95% CI: 1.32-2.07), the incidence of fractures decreased significantly (RR = 0.57, 95% CI: 0.45-0.072), with no significant difference observed in mortality rates between treatment and control groups.

Conclusion: Teriparatide improves lumbar spine and femoral neck BMD in postmenopausal women. Particularly notable is the novel finding regarding its effect on radius BMD, an area less explored in previous research. Despite an uptick in adverse events, the marked decrease in fracture incidence confirms its clinical utility for high-risk osteoporosis patients, highlighting the necessity for ongoing investigations into its full skeletal effects.

Keywords: fractures; parathyroid hormone; postmenopausal osteoporosis; systematic review; teriparatide.

Figure 1

Literature screening flowchart.

Figure 2

(A) A proportional risk of bias graph is presented, showcasing the percentage of biased items from all the studies included in the analysis (20, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71). This visual representation allows for a clear judgment of the level of bias present in the studies and provides insight into the overall reliability of the results. (B) Diagram Illustrating Risk of Bias: Evaluating Bias in Various Aspects Across Included Studies (20, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71).

Figure 3

Forest plot comparing the incidence of fractures between teriparatide and control groups (20, 51, 52, 53, 54, 55, 57, 60, 61, 62, 64).

Figure 4

This forest plot diagram illustrates changes in bone mineral density between teriparatide and placebo treatments at the hip (52, 54, 55, 59, 61, 65, 67, 69, 70, 71, 72).

Figure 5

This forest plot diagram illustrates changes in bone mineral density between teriparatide and placebo treatments at the lumbar spine (50, 51, 52, 53, 54, 54, 56, 57, 59, 60, 61, 62, 63, 64, 65, 66, 68, 69, 70, 71).

Figure 6

This forest plot diagram illustrates changes in bone mineral density between teriparatide and placebo treatments at the femoral neck (20, 53, 54, 55, 56, 59, 60, 62, 63, 64, 65, 68, 70, 71).

Figure 7

This forest plot diagram illustrates changes in bone mineral density between teriparatide and placebo treatments at the radial bone (20, 56, 60).

Figure 8

(A) Forest plot illustrating the effects of teriparatide and placebo treatments on osteocalcin at 6 and 12 months (56, 59). (B) Forest plot illustrating the effects of teriparatide and placebo treatments on P1NP at 6,12, and 18 months (50, 55, 56, 58, 59, 62). (C) Forest plot illustrating the effects of teriparatide and placebo treatments on CTx changes at 6 and 12 (50, 55, 59).

Figure 9

(A) Forest plot comparing the safety of teriparatide and placebo treatments in terms of adverse events (20, 50, 51, 52, 53, 54, 55, 56, 57, 60, 61, 62, 64). (B) Forest plot comparing the safety of teriparatide and placebo treatments in terms of Sudden death (20, 50, 51, 52, 53, 54, 55, 57, 60, 61, 62, 64).