Arthur Vithran Djandan Tadum, Essien Anko Elijah, Rahmati Masoud, Opoku Michael, Keon Yon Dong, López Sánchez Guillermo F, Koyanagi Ai, Smith Lee, Il Shin Jae, Xiao Wenfeng, Liu Shuguang, Li Yusheng
Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan, China.
National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
EFORT Open Rev. 2024 Sep 2;9(9):845-861. doi: 10.1530/EOR-23-0205.
The aim of the study was to evaluate the efficacy and safety of teriparatide compared to other treatments for postmenopausal osteoporosis.
A review of studies from 2000 to January 2023 analyzed randomized controlled trials on postmenopausal women treated with teriparatide (PTH 1-34), comparing it to placebo or other osteoporosis treatments. The analysis focused on bone mineral density (BMD), bone turnover markers, and clinical outcomes, employing Review Manager 5.4.1 and the RoB 2 tool for bias assessment.
Our analysis of 23 randomized controlled trials (RCTs) found that PTH (134) treatment significantly increased lumbar spine BMD (mean difference (MD) = 0.02, 95% CI: 0.01-0.03) and femoral neck BMD (MD = 0.01, 95% CI: 0.00-0.01). However, there were no significant changes in total hip and radial bone BMD among the 3536 and 2046 participants, respectively. We also found that PTH (1-34) increased P1NP in a larger cohort (n = 1415) when compared to osteocalcin (n = 206). Although the risk of adverse events increased (relative risk (RR) = 1.65, 95% CI: 1.32-2.07), the incidence of fractures decreased significantly (RR = 0.57, 95% CI: 0.45-0.072), with no significant difference observed in mortality rates between treatment and control groups.
Teriparatide improves lumbar spine and femoral neck BMD in postmenopausal women. Particularly notable is the novel finding regarding its effect on radius BMD, an area less explored in previous research. Despite an uptick in adverse events, the marked decrease in fracture incidence confirms its clinical utility for high-risk osteoporosis patients, highlighting the necessity for ongoing investigations into its full skeletal effects.
本研究旨在评估特立帕肽与其他治疗绝经后骨质疏松症的方法相比的疗效和安全性。
对2000年至2023年1月的研究进行综述，分析了关于用特立帕肽（甲状旁腺激素1-34）治疗绝经后妇女的随机对照试验，并将其与安慰剂或其他骨质疏松症治疗方法进行比较。分析重点关注骨矿物质密度（BMD）、骨转换标志物和临床结局，采用Review Manager 5.4.1和RoB 2工具进行偏倚评估。
我们对23项随机对照试验（RCT）的分析发现，甲状旁腺激素（1-34）治疗显著提高了腰椎骨密度（平均差值（MD）=0.02，95%置信区间：0.01-0.03）和股骨颈骨密度（MD = 0.01，95%置信区间：0.00-0.01）。然而，在3536名和2046名参与者中，全髋和桡骨骨密度分别没有显著变化。我们还发现，与骨钙素组（n = 206）相比，甲状旁腺激素（1-34）在更大的队列（n = 1415）中使I型前胶原氨基端前肽（P1NP）升高。虽然不良事件风险增加（相对风险（RR）= 1.65，95%置信区间：1.32-2.07），但骨折发生率显著降低（RR = 0.57，95%置信区间：0.45-0.72），治疗组和对照组之间的死亡率没有显著差异。
特立帕肽可改善绝经后妇女的腰椎和股骨颈骨密度。特别值得注意的是关于其对桡骨骨密度影响的新发现，这是以往研究较少探索的领域。尽管不良事件有所增加，但骨折发生率的显著降低证实了其对高危骨质疏松症患者的临床实用性，凸显了持续研究其对整个骨骼影响的必要性。
