Key clinical point: Teriparatide reduces the risk of vertebral and nonvertebral fractures and improves bone mineral density (BMD) vs. bisphosphonates in patients with postmenopausal osteoporosis.

Major finding: Teriparatide vs. bisphosphonate group had a lower total occurrence of vertebral fractures (risk ratio [RR ], 0.55; P  =  .001) and nonvertebral fractures (RR , 0.65; P  =  .009) and improved BMD at the lumbar spine (weighted mean difference [WMD], 1.03; P = .000) and femoral neck (WMD, 0.85; P = .000). The rate of complications was comparable between the groups (RR, 1.05; P = .516).

Study details: Meta-analysis of 14 randomized controlled trials.

Disclosures: No study sponsor was identified. The authors declared no conflict of interest.

Commentary

“Bisphosphonates and teriparatide are commonly used to treat osteoporosis. This meta-analysis and systematic review included 14 randomized controlled trials and examined the efficacy and safety of teriparatide and bisphosphonates for the treatment of postmenopausal osteoporosis. In terms of efficacy, there was a lower risk of vertebral fractures (RR = 0.55, 95% CI: 0.40–0.77) and nonvertebral fractures (RR = 0.65, 95% CI: 0.46–0.90) in the patients treated with teriparatide compared to those on bisphosphonates.

Unsurprisingly, compared with the bisphosphonate group, the teriparatide group had better bone mineral density at the lumbar spine and femoral neck at the last follow-up. In terms of safety, no significant difference was found between these two treatments. Limitations include potential for selection bias in some studies, use of different definitions for osteoporosis, limited follow up for adverse events, and lack of assessment of quality of life between these groups. Future studies evaluating important patient outcomes such as quality of life are needed. “

Maria I. Danila, MD, MSc, MSPH

University of Alabama at Birmingham