Affiliation:
1. Endocrinology and Metabolism, The Affiliated Hospital of Qingdao
University, Qingdao, China
2. Endocrinology, Fudan University, Shanghai, China
Abstract
AbstractOsteoporosis (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.
Funder
Shandong Provincial Natural Science Foundation
National Natural Science Foundation of China
Subject
Biochemistry (medical),Clinical Biochemistry,Endocrinology,Biochemistry,General Medicine,Endocrinology, Diabetes and Metabolism
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