Osteoporosis: teriparatide tops 3 other nonbisphosphonates

  • Bone

  • International Clinical Digest
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Takeaway

  • 4 non-bisphosphonates were more effective than placebo in reducing vertebral and hip fractures in patients with osteoporosis.
  • In network meta-analysis, teriparatide had the highest probability of being more effective vs romosozumab, denosumab, and raloxifene (in decreasing order of efficacy).

Why this matters

  • This is the first network meta-analysis of non-bisphosphonates.

Study design

  • Network meta-analysis of non-bisphosphonates (n=46 randomised controlled trials [RCTs]) after search of 9 electronic databases.
  • Funding: National Institute for Health Research Health Technology Assessment Programme.

Key results

  • All 4 non-bisphosphonates were more effective than placebo in reducing vertebral fracture, with teriparatide having the highest probability of being the top treatment (prediction interval, 0.38):
    • Teriparatide: HR, 0.23; 95% credible interval (CrI), 0.16-0.32.
    • Romosozumab for 1 year followed by alendronate: HR, 0.25; 95% CrI, 0.15-0.43.
    • Denosumab: HR, 0.30; 95% CrI, 0.21-0.43.
    • Raloxifene: HR, 0.61; 95% CrI, 0.44-0.80.
  • All 4 non-bisphosphonates were more effective than placebo in reducing hip fracture (except raloxifene), with teriparatide having the highest probability of being the top treatment (prediction interval, 0.50):
    • Teriparatide: HR, 0.35; 95% CrI, 0.15-0.73.
    • Romosozumab for 1 year followed by alendronate: HR, 0.39; 95% CrI, 0.21-0.72.
    • Denosumab: HR, 0.56; 95% CrI, 0.31-0.94.
    • Raloxifene: HR, 0.94; 95% CrI, 0.31-2.67.

Limitations

  • Heterogeneity across RCTs.