Comparison between teriparatide and bisphosphonates for improving bone mineral density in postmenopausal osteoporosis patients A meta-analysis

Background: We performed a systematic review and meta-analysis of the efficacy and safety of teriparatide and bisphosphonates in managing postmenopausal osteoporosis. Methods: PubMed, EMBASE, Web of Science, and China National Knowledge Infrastructure were searched for relevant randomized controlled trials that were published before April 2018 and compared teriparatide and bisphosphonates in treating postmenopausal osteoporosis. Stata 12.0 was used for the meta-analysis. The pooled risk ratio (RR) or weighted mean difference and 95% confidence interval (CI) were calculated using a fixed effects or random effects meta-analysis. Results: A total of 14 randomized controlled trials were included in this meta-analysis. The teriparatide group was associated with a lower total occurrence of vertebral fractures (RR=0.55, 95% CI: 0.40-0.77; P=.001) and nonvertebral fractures (RR=0.65, 95% CI: 0.46-0.90; P=.009) than the bisphosphonate group. Moreover, compared with the bisphosphonate group, the teriparatide group had improved bone mineral density at the lumbar spine and femoral neck at the final follow-up (P<.05). There was no significant difference between the teriparatide and bisphosphonate groups in terms of complications (RR=1.05, 95% CI: 0.90, 1.22, P=.516). Conclusions: Teriparatide significantly reduced the occurrence of vertebral and nonvertebral fractures in osteoporosis patients. More studies should focus on the quality of life of patients using these 2 drugs.