Nunkoo Sarvesh, Krissheeven Mooroogiah, Chitravanshi Anusha, Ramanah Maheshwara, Robinson Jared, Banerjee Indrajit
Pharmacology, Sir Seewoosagur Ramgoolam Medical College, Belle Rive, MUS.
Surgery, Sir Seewoosagur Ramgoolam Medical College, Belle Rive, MUS.
Cureus. 2024 Nov 5;16(11):e73068. doi: 10.7759/cureus.73068. eCollection 2024 Nov.
Alendronate, a second-generation bisphosphonate, remains the first-line therapeutic option for postmenopausal osteoporosis. It acts on the bone resorbing osteoclasts causing their apoptosis. This is achieved by producing toxic adenosine triphosphate (ATP) analogues and interfering with the mevalonate pathway. Teriparatide, a recombinant form of parathyroid hormone, is an alternative option to this more conventional drug. It is an anabolic drug that mediates its biological effect via specific, high-affinity membrane cell-surface receptors expressed on the osteoblasts. It promotes bone formation more than bone resorption. Hence, this research was conducted to delineate the effectiveness and clinical safety of teriparatide as compared to alendronate in women suffering from postmenopausal osteoporosis. An extensive search was conducted through PubMed, Google Scholar, Trip (Turning Research into Practice), and Cochrane Central Register of Controlled Trials (CENTRAL) including studies published between August 2017 and October 2024 in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines 2020. The Medical Subject Headings (MeSH) terms and Boolean operators used were "Alendronate" OR "Diphosphonates" OR "Teriparatide" OR "Treatment Outcome" OR "Postmenopause" AND "Osteoporosis". Randomized controlled trials were included in this systematic review. Five full-text articles were ultimately considered and critical appraisal was performed thereon. The annual incidence rate of morphometric vertebral fracture in the sequential therapy (teriparatide) group (0.1020 and 0.1334) was significantly lower than monotherapy (alendronate) (0.1492 and 0.1734). Quality of life (QoL) by week 12 was better in teriparatide than alendronate and no patient encountered any severe adverse effects with teriparatide after 72 weeks of treatment. Thus, based on the results, teriparatide is more effective than alendronate in increasing the bone mineral density (BMD) of L2-4 vertebrae and the hip bone. However, alendronate is better in the case of femoral neck fractures. Furthermore, spinal strength shows a better response in the trabecular than peripheral compartment with teriparatide. Teriparatide is also safer than alendronate due to its lower incidence rate in morphometric vertebral fracture, lack of severe adverse effects and better QoL. Teriparatide showed comparable inhibition of vertebral collapse, increase in BMD, promotion of bone union, and improvement of pain.
阿仑膦酸钠是第二代双膦酸盐类药物，仍是绝经后骨质疏松症的一线治疗选择。它作用于骨吸收破骨细胞，导致其凋亡。这是通过产生有毒的三磷酸腺苷（ATP）类似物并干扰甲羟戊酸途径来实现的。特立帕肽是甲状旁腺激素的重组形式，是这种更传统药物的替代选择。它是一种促合成代谢药物，通过成骨细胞上表达的特异性、高亲和力膜细胞表面受体介导其生物学效应。它促进骨形成的作用大于骨吸收。因此，本研究旨在阐明与阿仑膦酸钠相比，特立帕肽在绝经后骨质疏松症女性中的有效性和临床安全性。通过PubMed、谷歌学术、Trip（将研究转化为实践）和Cochrane对照试验中央注册库（CENTRAL）进行了广泛检索，纳入了2017年8月至2024年10月发表的符合2020年系统评价和Meta分析优先报告项目（PRISMA）指南的研究。使用的医学主题词（MeSH）术语和布尔运算符为“阿仑膦酸钠”或“双膦酸盐类”或“特立帕肽”或“治疗结果”或“绝经后”和“骨质疏松症”。本系统评价纳入了随机对照试验。最终考虑了五篇全文文章并对其进行了批判性评价。序贯治疗（特立帕肽）组的形态计量学椎体骨折年发病率（0.1020和0.1334）显著低于单药治疗（阿仑膦酸钠）组（0.1492和0.1734）。特立帕肽治疗12周时的生活质量（QoL）优于阿仑膦酸钠，且治疗72周后特立帕肽组无患者出现任何严重不良反应。因此，根据结果，特立帕肽在增加L2 - 4椎体和髋部骨密度（BMD）方面比阿仑膦酸钠更有效。然而，在股骨颈骨折方面阿仑膦酸钠更好。此外，特立帕肽治疗时，小梁骨区的脊柱强度反应优于外周骨区。特立帕肽在形态计量学椎体骨折发病率较低、无严重不良反应且生活质量较好方面也比阿仑膦酸钠更安全。特立帕肽在抑制椎体塌陷、增加骨密度、促进骨愈合和改善疼痛方面表现相当。
