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Horm Metab Res 2023; 55(04): 236-244
DOI: 10.1055/a-2015-1747
Original Article: Endocrine Care

Comparison of Bisphosphonates Versus Teriparatide in Therapy of the Glucocorticoid-Induced Osteoporosis (GIOP): A Meta-Analysis of Randomized Controlled Trials

Bingzi Dong
1   Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, Qingdao, China
,
Yue Zhou
1   Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, Qingdao, China
2   Endocrinology, Fudan University, Shanghai, China
,
Jun Wang
1   Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, Qingdao, China
,
Chengqian Li
1   Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, Qingdao, China
,
Zhengju Fu
1   Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, Qingdao, China
,
Yajing Huang
1   Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, Qingdao, China
,
Yangang Wang
1   Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, Qingdao, China
,
Lili Xu
1   Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, Qingdao, China
› Author Affiliations Funding Information Shandong Provincial Natural Science Foundation — Grant No. ZR2016HB08 National Natural Science Foundation of China — 81600691
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Abstract

Osteoporosis (OP) is characterized as decreased bone mineral density (BMD) and increased risk of bone fracture. Secondary OP resulting from excess endogenous or exogenous glucocorticoid is defined as glucocorticoid-induced osteoporosis (GIOP). Current therapeutic strategies for GIOP are similar to menopausal osteoporosis, including calcium and vitamin D supplementation, bisphosphonates, and parathyroid hormone (PTH) analogues (teriparatide). Previously, several published meta-analyses compared anti-osteoporotic agents for the menopausal or aging-dependent OP. However, the physiopathologic bone metabolism of GIOP is different. In this study, we investigated the efficacy of BMD enhancement, bone fracture rate and safety of bisphosphonates versus teriparatide in the therapy of GIOP. We searched databases including PubMed, Embase, and the Cochrane Library until Jan 2023, and selected ten random clinical trials (RCT)s that compared the efficacy and/or safety of bisphosphonate versus teriparatide for GIOP patients. Teriparatide therapy increased lumber spinal BMD by 3.96% (95% CI 3.01–4.9%, p<0.00001), 1.23% (95% CI 0.36–2.1%, p=0.006) at total hip, and 1.45% (95% CI 0.31–2.58%, p=0.01) at femoral neck, respectively, compared to bisphosphonates at 18-month therapy for GIOP. Teriparatide also reduced bone fracture especially in vertebral bone (p=0.0001, RR 6.27, 95% CI 2.44–16.07), and increased bone formation and resorption marker levels. There was no difference in the incidence of adverse effects in bisphosphonate and teriparatide groups. Teriparatide showed better performance over bisphosphonate in BMD enhancement, bone fracture reduction, and bone remodeling improvement, without increasing the incidence of adverse effects.

Key words

glucocorticoid-induced osteoporosis - bisphosphonate - teriparatide - bone mineral density - bone fracture

Supplementary Material



Publication History

Received: 04 June 2022

Accepted after revision: 18 January 2023

Accepted Manuscript online:
18 January 2023

Article published online:
23 February 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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