Study summary · research use only
Clinical Application of Teriparatide in Fracture Prevention: A Systematic Review
Plain-language summary
Paraphrased from the published abstract below — not a verdict on whether anything works.
This systematic review of human studies examined teriparatide, a 1-34 fragment of parathyroid hormone (PTH), for fracture prevention in osteoporotic individuals. Seventeen studies were included; of the 17 eligible studies, 3 were rated high quality, 3 moderate quality, 6 low quality, and 5 critically low quality using AMSTAR 2. Compared with placebo, teriparatide was associated with reduced vertebral and overall nonvertebral fractures across subgroups including postmenopausal, glucocorticoid-treated, and chronic kidney disease patients, but not with reduced site-specific wrist or hip fractures. Teriparatide was not associated with greater reduction in fracture risk compared with other medications such as bisphosphonates, selective estrogen receptor modulators, a RANKL inhibitor, or strontium ranelate. The authors report that teriparatide was not associated with an increased rate of adverse events compared with other drugs.
Abstract
Teriparatide, a 1-34 fragment of parathyroid hormone (PTH) that maintains most of the biological activities of PTH, has been employed since 2002 as an anabolic agent for osteoporotic individuals who are at high risk of fracture. The purpose of the present review is to provide a systematic summary and timely update on treatment with teriparatide for fracture prevention. Electronic databases, including OVID MEDLINE, OVID Embase, and the Cochrane Library, were searched on February 9, 2018, to identify published systematic reviews and meta-analyses addressing treatment with teriparatide for fracture prevention, and A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2) was used to assess the quality of included studies. Seventeen studies were included. Of the 17 eligible studies, 3 were rated as high quality, 3 were rated as moderate quality, 6 were rated as low quality, and 5 were rated as critically low quality. Teriparatide reduced vertebral and overall nonvertebral fractures in osteoporotic patients regardless of the existence of precipitating conditions, including postmenopausal status, glucocorticoid treatment, and chronic kidney disease, as compared with placebo, but not the site-specific nonvertebral fractures of the wrist and hip. Teriparatide did not more effectively reduce fracture risks when compared with other medications, such as bisphosphonates, selective estrogen receptor modulators, RANKL (receptor activator of nuclear factor kappa-beta ligand) inhibitor, or strontium ranelate. Teriparatide was safe and was not associated with an increased rate of adverse events when compared with other drugs. Teriparatide was effective for the prevention of vertebral and overall nonvertebral fractures in osteoporotic patients but not for the prevention of site-specific nonvertebral fractures at the wrist and hip. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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