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

Bingzi Dong; Yue Zhou; Jun Wang; Chengqian Li; Zhengju Fu; Yajing Huang; Yangang Wang; Lili Xu

doi:10.1055/a-2015-1747

Hormone and Metabolic Research, Table of Contents

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

Authors

Bingzi Dong

¹Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, Qingdao, China
Yue Zhou

¹Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, Qingdao, China

²Endocrinology, Fudan University, Shanghai, China
Jun Wang

¹Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, Qingdao, China
Chengqian Li

¹Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, Qingdao, China
Zhengju Fu

¹Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, Qingdao, China
Yajing Huang

¹Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, Qingdao, China
Yangang Wang

¹Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, Qingdao, China
Lili Xu

¹Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, Qingdao, China

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

Full Text

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