Comparison of Teriparatide, Denosumab & Oral Bisphosphonates
Comparison of Teriparatide, Denosumab & Oral Bisphosphonates
Objective. This study aims to compare the efficacy of teriparatide, denosumab, and oral bisphosphonates for reducing fracture risk in postmenopausal women with osteoporosis.
Methods. We searched the literature, via PubMed, Medline, Embase, and the Cochrane Library, to screen citations from January 1996 to October 2014 for inclusion in this study. A mixed-treatment comparison meta-analysis within a Bayesian framework was performed by WinBUGS version 1.4.3 software. The proportions of women with vertebral fractures and women with nonvertebral fractures were analyzed.
Results. Our meta-analysis results indicated that all of the therapies—except etidronate—achieved a statistically significant reduction of fractures compared with placebo. Teriparatide and denosumab were more effective than alendronate and risedronate for reducing vertebral fracture (teriparatide vs alendronate: odds ratio [OR], 1.76; 95% CI, 1.03-2.98; teriparatide vs risedronate: OR, 1.92; 95% CI, 1.13-3.19; denosumab vs alendronate: OR, 1.67; 95% CI, 1.06-2.67; denosumab vs risedronate: OR, 1.84; 95% CI, 1.16-2.92). Teriparatide, denosumab, alendronate, and risedronate also reduced the risk of nonvertebral fracture compared with placebo. Results of subgroup analysis showed that denosumab (OR, 0.6; 95% CI, 0.37-0.98), alendronate (OR, 0.61; 95% CI, 0.39-0.96), and risedronate (OR, 0.63; 95% CI, 0.46-0.86) can reduce the risk of hip fracture and that risedronate (OR, 0.59; 95% CI, 0.4-0.88) can also reduce the risk of upper-arm fracture.
Conclusions. Teriparatide, denosumab, alendronate, and risedronate are effective in reducing the risk of vertebral and nonvertebral fractures in postmenopausal women with osteoporosis. Furthermore, denosumab, alendronate, and risedronate can reduce the risk of hip fracture, and risedronate can also reduce the risk of upper-arm fracture.
Osteoporosis, characterized by low bone mineral density, deterioration of bone structure, and high risk of fracture, is primarily present in postmenopausal women. Among fractures related to osteoporosis, approximately 70% occur in nonvertebral locations and 30% occur at the spine. Vertebral and nonvertebral fractures are associated with substantial mortality and healthcare costs.
The most common interventions for the treatment of osteoporosis and the prevention of fractures are oral bisphosphonates (eg, alendronate, etidronate, ibandronate, and risedronate). Teriparatide is a skeletal anabolic drug approved for use in postmenopausal women with osteoporosis who are at high risk for fracture. Results of previous studies have shown that teriparatide reduced the risk of vertebral and nonvertebral fractures in postmenopausal women with osteoporosis. Denosumab is a human monoclonal IgG2 antibody against the receptor activator of nuclear factor-ΚΒ ligand. In postmenopausal women with osteoporosis, denosumab 60 mg every 60 months has been shown to reduce the incidence of vertebral and nonvertebral fractures.
Currently, randomized controlled trials (RCTs) of fracture risk reduction in women with osteoporosis are placebo-controlled and do not provide head-to-head comparisons. Because there is a lack of head-to-head studies comparing all relevant therapies, traditional methods cannot be applied for comparison. Therefore, we used mixed-treatment comparison (MTC), which was available for indirect comparison of drugs with different comparators, to compare the efficacy of teriparatide, denosumab, and oral bisphosphonates.
Abstract and Introduction
Abstract
Objective. This study aims to compare the efficacy of teriparatide, denosumab, and oral bisphosphonates for reducing fracture risk in postmenopausal women with osteoporosis.
Methods. We searched the literature, via PubMed, Medline, Embase, and the Cochrane Library, to screen citations from January 1996 to October 2014 for inclusion in this study. A mixed-treatment comparison meta-analysis within a Bayesian framework was performed by WinBUGS version 1.4.3 software. The proportions of women with vertebral fractures and women with nonvertebral fractures were analyzed.
Results. Our meta-analysis results indicated that all of the therapies—except etidronate—achieved a statistically significant reduction of fractures compared with placebo. Teriparatide and denosumab were more effective than alendronate and risedronate for reducing vertebral fracture (teriparatide vs alendronate: odds ratio [OR], 1.76; 95% CI, 1.03-2.98; teriparatide vs risedronate: OR, 1.92; 95% CI, 1.13-3.19; denosumab vs alendronate: OR, 1.67; 95% CI, 1.06-2.67; denosumab vs risedronate: OR, 1.84; 95% CI, 1.16-2.92). Teriparatide, denosumab, alendronate, and risedronate also reduced the risk of nonvertebral fracture compared with placebo. Results of subgroup analysis showed that denosumab (OR, 0.6; 95% CI, 0.37-0.98), alendronate (OR, 0.61; 95% CI, 0.39-0.96), and risedronate (OR, 0.63; 95% CI, 0.46-0.86) can reduce the risk of hip fracture and that risedronate (OR, 0.59; 95% CI, 0.4-0.88) can also reduce the risk of upper-arm fracture.
Conclusions. Teriparatide, denosumab, alendronate, and risedronate are effective in reducing the risk of vertebral and nonvertebral fractures in postmenopausal women with osteoporosis. Furthermore, denosumab, alendronate, and risedronate can reduce the risk of hip fracture, and risedronate can also reduce the risk of upper-arm fracture.
Introduction
Osteoporosis, characterized by low bone mineral density, deterioration of bone structure, and high risk of fracture, is primarily present in postmenopausal women. Among fractures related to osteoporosis, approximately 70% occur in nonvertebral locations and 30% occur at the spine. Vertebral and nonvertebral fractures are associated with substantial mortality and healthcare costs.
The most common interventions for the treatment of osteoporosis and the prevention of fractures are oral bisphosphonates (eg, alendronate, etidronate, ibandronate, and risedronate). Teriparatide is a skeletal anabolic drug approved for use in postmenopausal women with osteoporosis who are at high risk for fracture. Results of previous studies have shown that teriparatide reduced the risk of vertebral and nonvertebral fractures in postmenopausal women with osteoporosis. Denosumab is a human monoclonal IgG2 antibody against the receptor activator of nuclear factor-ΚΒ ligand. In postmenopausal women with osteoporosis, denosumab 60 mg every 60 months has been shown to reduce the incidence of vertebral and nonvertebral fractures.
Currently, randomized controlled trials (RCTs) of fracture risk reduction in women with osteoporosis are placebo-controlled and do not provide head-to-head comparisons. Because there is a lack of head-to-head studies comparing all relevant therapies, traditional methods cannot be applied for comparison. Therefore, we used mixed-treatment comparison (MTC), which was available for indirect comparison of drugs with different comparators, to compare the efficacy of teriparatide, denosumab, and oral bisphosphonates.