Shandong University of Traditional Chinese Medicine CN, Jinan, China.
Affiliated Hospital of Shandong University of Traditional Chinese Medicine CN, Jinan, China.
J Orthop Surg Res. 2023 Jun 22;18(1):447. doi: 10.1186/s13018-023-03920-4.
Continuous use of glucocorticoids (GCs) has become the primary cause of secondary osteoporosis. Bisphosphonate drugs were given priority over denosumab and teriparatide in the 2017 American College of Rheumatology (ACR) guidelines but have a series of shortcomings. This study aims to explore the efficacy and safety of teriparatide and denosumab compared with those of oral bisphosphonate drugs.
We systematically searched studies included in the PubMed, Web of Science, Embase, and Cochrane library databases and included randomized controlled trials that compared denosumab or teriparatide with oral bisphosphonates. Risk estimates were pooled using both fixed and random effects models.
We included 10 studies involving 2923 patients who received GCs for meta-analysis, including two drug base analyses and four sensitivity analyses. Teriparatide and denosumab were superior to bisphosphonates in increasing the bone mineral density (BMD) of the lumbar vertebrae [teriparatide: mean difference [MD] 3.98%, 95% confidence interval [CI] 3.61-4.175%, P = 0.00001; denosumab: MD 2.07%, 95% CI 0.97-3.17%, P = 0.0002]. Teriparatide was superior to bisphosphonates in preventing vertebral fractures and increasing hip BMD [MD 2.39%, 95% CI 1.47-3.32, P < 0.00001]. There was no statistically significant difference between serious adverse events, adverse events, and nonvertebral fracture prevention drugs.
Teriparatide and denosumab exhibited similar or even superior characteristics to bisphosphonates in our study, and we believe that they have the potential to become first-line GC-induced osteoporosis treatments, especially for patients who have previously received other anti-osteoporotic drugs with poor efficacy.
连续使用糖皮质激素（GCs）已成为继发性骨质疏松症的主要原因。在 2017 年美国风湿病学会（ACR）指南中，双膦酸盐药物优先于地舒单抗和特立帕肽，但它们也存在一系列缺点。本研究旨在探讨特立帕肽和地舒单抗与口服双膦酸盐药物相比的疗效和安全性。
我们系统地检索了 PubMed、Web of Science、Embase 和 Cochrane 图书馆数据库中的研究，并纳入了比较地舒单抗或特立帕肽与口服双膦酸盐药物的随机对照试验。使用固定效应模型和随机效应模型汇总风险估计值。
我们纳入了 10 项研究，共 2923 名接受 GCs 治疗的患者进行荟萃分析，包括 2 项药物基础分析和 4 项敏感性分析。特立帕肽和地舒单抗在增加腰椎骨密度（BMD）方面优于双膦酸盐[特立帕肽：平均差值（MD）3.98%，95%置信区间（CI）3.61-4.175%，P=0.00001；地舒单抗：MD 2.07%，95%CI 0.97-3.17%，P=0.0002]。特立帕肽在预防椎体骨折和增加髋部 BMD 方面优于双膦酸盐[MD 2.39%，95%CI 1.47-3.32，P<0.00001]。严重不良事件、不良事件和非椎体骨折预防药物之间无统计学差异。
在本研究中，特立帕肽和地舒单抗在某些方面表现出与双膦酸盐相似甚至更优的特性，我们认为它们有可能成为治疗 GC 诱导的骨质疏松症的一线药物，特别是对于那些之前使用其他疗效不佳的抗骨质疏松药物的患者。
