Bruce E. Johnson, MD
Does teriparatide increase bone mineral density (BMD) or reduce fractures in postmenopausal women with osteoporosis?
Included studies compared daily subcutaneous injections of teriparatide for > 6 months with placebo in primarily postmenopausal women with osteoporosis, who had no coexisting medical conditions or treatments that would affect bone or calcium metabolism. Teriparatide could be combined with antiresorptive (AR) agents and compared with AR agents alone. Outcomes were spine and hip BMD and vertebral and nonvertebral fractures.
PubMed, ISI Web of Knowledge, and Cochrane Central Register of Controlled Trials (1966 to Apr 2011) and bibliographies of selected articles were searched for randomized placebo-controlled trials. 8 trials (n = 2388) with durations ranging from 6 to 36 months met the selection criteria: 8 reported on BMD and 4 on fractures. 4 trials compared teriparatide with placebo, and 4 compared teriparatide plus AR agents with AR agents alone. 4 trials had adequate randomization sequence generation and blinding of outcome assessors; 4 were unclear on both of these.
Meta-analysis of 8 trials (n = 2206) showed that teriparatide increased spine BMD by 8.1% (95% CI 6.7 to 9.6), and meta-analysis of 7 trials (n = 1303) showed that teriparatide increased hip BMD by 2.5% (CI 1.7 to 3.3) compared with placebo; there was significant statistical heterogeneity (P < 0.01) across study results for BMD outcomes. Teriparatide reduced risk for vertebral and nonvertebral fractures (Table).
In postmenopausal women with osteoporosis, teriparatide increases bone mineral density and reduces fractures.
Teriparatide vs control (placebo or antiresorptive agents) in postmenopausal women with osteoporosis*
*Abbreviations defined in Glossary. Weighted teriparatide event rates, NNT, and CI calculated from control event rates and relative risks in article.
Bruce E. Johnson. Review: Teriparatide reduces fractures in postmenopausal women with osteoporosis. Ann Intern Med. 2012;157:JC3–4. doi: 10.7326/0003-4819-157-6-201209180-02004
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Published: Ann Intern Med. 2012;157(6):JC3-4.
Endocrine and Metabolism, Metabolic Bone Disorders.
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