Weniger Stürze unter Teriparatid in Patienten mit Osteoporose: Eine Meta-Analyse

Zusammenfassung

Einleitung Da Stürze ein Risikofaktor für Frakturen sind, war das Ziel dieser Meta-Analyse, den Effekt von Teriparatid auf das Sturzrisiko bei Patienten mit Osteoporose zu bewerten.

Methoden Eine systematische Suche nach randomisierten, klinischen Studien mit Teriparatid wurde in Pubmed und der Datenbank clinicaltrials.gov durchgeführt. Entsprechend der Einschlusskriterien geeignete Studien wurden für die Meta-Analyse verwendet und Odds Ratios (OR) sowie die dazugehörigen 95 %-Konfidenzintervalle (95 %-KI) berechnet.

Ergebnisse Es wurden neun Studien mit 5.822 Patienten identifiziert und in diese Meta-Analyse eingeschlossen. Die Analyse zeigte, dass Patienten unter Teriparatid ein statistisch signifikant geringeres Risiko für einen Sturz hatten als Patienten in der Kontrollgruppe (OR: 0,75; 95 % KI: 0,56–1,00; p = 0,05; n = 5.822). Gegenüber einer reinen Bisphosphonat-Kontrollgruppe zeigte Teriparatid eine nichtsignifikante Reduktion des Sturzrisikos (OR: 0,77; 95 % KI: 0,55–1,06; p = 0,11; n = 2.658).

Schlussfolgerung Teriparatid senkte in dieser Meta-Analyse das Sturzrisiko signifikant gegenüber der Kontrollgruppe und könnte somit bei Patienten mit Osteoporose und hohem Sturzrisiko vorteilhaft sein.

Abstract

Introduction Falls are a risk factor for osteoporotic fractures and the DVO guidelines recommend to evaluate and decrease the risk of falls in patients with osteoporosis. Therefore, the aim of this meta-analysis was to evaluate the effect of Teriparatide on the risk of falls in patients with osteoporosis.

Methods Randomized clinical trials with Teriparatide were systematically searched on Pubmed and clinicaltrials.gov. Trials which met the following criteria, [1] treatment with 20 µg Teriparatide once daily, [2] randomized trial, [3] study duration of ≤24 months, [4] at least one Teriparatide-free control group, and [5] treatment of patients with osteoporosis and / or glucocorticoid-induced osteoporosis [GIOP], were included into the meta-analysis. Odds ratios (OR) and corresponding 95 % confidence intervals (CI) were calculated using a binary effects was model.

Results A total of nine trials with 5,822 patients were identified and included into this meta-analysis. Teriparatid was compared in one trial to placebo, in one trial to placebo and abaloparatid, in one trial to Denosumab, in another one to Romosozumab and in five trials to bisphosphonates, respectively.

The meta-analysis with all nine trials indicated that Teriparatide reduces the risk of falls statistically significant by 25 % (OR: 0.75; 95 % CI: 0.56–1.00; p = 0.05 n = 5,822) compared to control group.

A subgroup analysis, stratified by treatment duration, revealed that the risk of falls is consistently lower in patients treated with Teriparatide over ≤12 months (OR: 0.52; 95 % CI: 0.28–0.96; p = 0.04; n = 978), 18 months (OR: 0.86; 95 % CI: 0.59–1.24; p = 0.41; n = 3,478) and 24 months (OR: 0.76; 95 % CI: 0.39–1.46; p = 0.41; n = 1,366), respectively. Nevertheless, only the subgroup analysis of the ≤12 months data was statistically significant.

A second meta-analysis comparing Teriparatide to bisphosphonates alone, showed a non-significant reduction in risk of falls by Teripratide of 23 % (OR: 0.77; 95 % CI: 0.55–1.06; p = 0.11; n = 2,658).

The heterogeneity was considered low in both meta-analysis as well as all subgroup analysis with I² values of 0 % in each case.

Conclusion This meta-analysis indicates that Teriparatide has a positive effect on risk of falls in patients with osteoporosis, showing a statistically significant risk reduction. Due to the fact that falls are a risk factor for fractures, guidelines recommend to evaluate the risk of falls in osteoporosis patients and to prevent them from future falls. Therefore, Teriparatide could be an appropriate treatment option for osteoporosis patients with a high risk for falls.

Schlüsselwörter

Teriparatid - Osteoporose - Stürze - Frailty

Keywords

Teriparatide - Osteoporosis - Falls - Frailty

Publication History

Received: 18 July 2019

Accepted: 07 October 2019

Article published online:
25 February 2020

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