Effects of teriparatide on hip and upper limb fractures in patients with osteoporosis: a systematic review and meta-analysis

Introduction:

In randomized clinical trials (RCTs) with teriparatide, the number of patients with incident hip fractures was small. We conducted a meta-analysis to evaluate the effects of teriparatide on hip and upper limb fractures compared to placebo or osteoporosis drugs in patients with osteoporosis.

Methods:

A literature search was conducted for RCTs of teriparatide of at least 6-month duration, with the approved treatment indications and dose, and that reported non-spine fractures (hip, humerus, forearm, wrist). Study selection and data extraction were performed by two independent reviewers. Statistical procedures included Peto's method and Mantel-Haenszel with empirical correction, as most of the RCTs reported zero events in at least one of the treatment arms. The results are expressed as odds ratios (OR) with 95% confidence intervals (CI). Publication bias and heterogeneity were assessed with standard statistical tests.

Results:

Twenty-three RCTs were included, 19 with an active-controlled arm, 11 double-blind, representing data on 8591 subjects (3888 treated with teriparatide). Mean age was 67.0 years, median treatment duration 18 months (range 6 – 24 months). Thirty-four incident hip, 28 humerus, 31 forearm, and 73 wrist fractures were reported. Metaanalysis results showed an OR (95% CI) for hip fractures of 0.44 (0.22 – 0.87; p = 0.019) in patients treated with teriparatide compared with controls (Figure). The effects on the risk of humerus [0.82 (0.38 – 1.74)], forearm [0.53 (0.26 – 1.08)] and wrist [1.14 (0.71 – 1.83)] fractures were not statistically significant.

Discussion:

This meta-analysis provides evidence of efficacy of teriparatide in reducing osteoporotic hip fractures by 56%. No significant effects were demonstrable for upper limb fractures.

Fig. 1: Efficacy of teriparatide versus comparators for reducing hip fracture