Teriparatide in Postmenopausal Osteoporosis: Uncovering Novel Insights into Efficacy and Safety Compared to Other Treatments - A Systematic Review and Meta-Analysis

Objective:

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 (RCTs) 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 (1-34) 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   3,536   and   2,046   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.

Conclusions:

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.