Comparative efficacy of teriparatide and bisphosphonates or denosumab vs. teriparatide monotherapy in osteoporosis: a meta-analysis
IntroductionTeriparatide (TPTD), a widely used bone-promoting drug in osteoporosis (OP) treatment, may cause compensatory bone resorption with long-term monotherapy (>6 months). Combining TPTD with anti-bone resorption drugs (e.g., bisphosphonates and denosumab) could reduce bone loss, yet ex...
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Frontiers Media S.A.
2025-05-01
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| author | Huan Jin Huan Jin Cai Huang Yan Zhang Ying Dong Qi Xiong Di Wang Di Wang Ziyi He Ziyi He Lin Shen Chen Ma Zixian Wang Bo Shuai |
| author_facet | Huan Jin Huan Jin Cai Huang Yan Zhang Ying Dong Qi Xiong Di Wang Di Wang Ziyi He Ziyi He Lin Shen Chen Ma Zixian Wang Bo Shuai |
| author_sort | Huan Jin |
| collection | DOAJ |
| description | IntroductionTeriparatide (TPTD), a widely used bone-promoting drug in osteoporosis (OP) treatment, may cause compensatory bone resorption with long-term monotherapy (>6 months). Combining TPTD with anti-bone resorption drugs (e.g., bisphosphonates and denosumab) could reduce bone loss, yet existing randomised controlled trials (RCTs) remain inconclusive regarding their effects on bone mineral density (BMD) and bone turnover markers (BTMs). This study aimed to systematically evaluate the effect of TPTD combined with bisphosphonates or denosumab on BMD and fracture risk in OP patients, compared with TPTD monotherapy.MethodsPubMed, Embase, Cochrane Library, and Web of Science databases (until March 2025) were searched for RCTs comparing TPTD monotherapy with combination therapy. Primary outcomes included vertebral/non-vertebral fracture risk reduction and BMD changes (lumbar spine, femoral neck, hip); secondary outcomes covered BTM variations and adverse events.ResultsEight RCTs (n = 787) were meta-analysed using Review Manager 5.4. Results showed: ① No significant differences in vertebral (OR = 0.93, 95%CI 0.12–6.93) or non-vertebral fractures (OR = 0.68, 0.31–1.46) between groups. ② TPTD combined with denosumab significantly increased lumbar spine (+3.40%, 0.44–6.36), femoral neck (+4.00%, 1.96–6.04), and hip BMD (+4.25%, 3.20–5.29). Bisphosphonate combinations improved hip BMD in the short term (<24 months: +1.81%, 0.65–2.97) but not long-term (≥24 months).③ Combination therapies regulated BTMs bidirectionally: bisphosphonates suppressed P1NP (40%–80% reduction vs. monotherapy), while denosumab preserved OC levels (-8–16% vs. monotherapy).④ Safety profiles were comparable: hypercalcemia incidence (16.3% vs. 14.7%, OR = 1.22, 0.55–2.69), musculoskeletal pain (9.8% overall), with no osteonecrosis cases reported.ConclusionTPTD-denosumab combination is clinically preferable for BMD enhancement, though its long-term (>24 months) fracture risk reduction requires further validation. |
| format | Article |
| id | doaj-art-c8d53ef684dd4064aeca2b5605d15c65 |
| institution | OA Journals |
| issn | 1663-9812 |
| language | English |
| publishDate | 2025-05-01 |
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| spelling | doaj-art-c8d53ef684dd4064aeca2b5605d15c652025-08-20T02:33:15ZengFrontiers Media S.A.Frontiers in Pharmacology1663-98122025-05-011610.3389/fphar.2025.16052791605279Comparative efficacy of teriparatide and bisphosphonates or denosumab vs. teriparatide monotherapy in osteoporosis: a meta-analysisHuan Jin0Huan Jin1Cai Huang2Yan Zhang3Ying Dong4Qi Xiong5Di Wang6Di Wang7Ziyi He8Ziyi He9Lin Shen10Chen Ma11Zixian Wang12Bo Shuai13Department of Integrated Traditional Chinese and Western Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, ChinaCollege of Sports Medicine, Wuhan Sports University, Wuhan, ChinaDepartment of Integrated Traditional Chinese and Western Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, ChinaDepartment of Pain, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, ChinaDepartment of internal medicine, Rongjun Hostipal of Hubei, Wuhan, ChinaDepartment of internal medicine, Rongjun Hostipal of Hubei, Wuhan, ChinaDepartment of Integrated Traditional Chinese and Western Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, ChinaCollege of Sports Medicine, Wuhan Sports University, Wuhan, ChinaDepartment of Integrated Traditional Chinese and Western Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, ChinaCollege of Sports Medicine, Wuhan Sports University, Wuhan, ChinaDepartment of Integrated Traditional Chinese and Western Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, ChinaDepartment of Integrated Traditional Chinese and Western Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, ChinaDepartment of Integrated Traditional Chinese and Western Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, ChinaDepartment of Integrated Traditional Chinese and Western Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, ChinaIntroductionTeriparatide (TPTD), a widely used bone-promoting drug in osteoporosis (OP) treatment, may cause compensatory bone resorption with long-term monotherapy (>6 months). Combining TPTD with anti-bone resorption drugs (e.g., bisphosphonates and denosumab) could reduce bone loss, yet existing randomised controlled trials (RCTs) remain inconclusive regarding their effects on bone mineral density (BMD) and bone turnover markers (BTMs). This study aimed to systematically evaluate the effect of TPTD combined with bisphosphonates or denosumab on BMD and fracture risk in OP patients, compared with TPTD monotherapy.MethodsPubMed, Embase, Cochrane Library, and Web of Science databases (until March 2025) were searched for RCTs comparing TPTD monotherapy with combination therapy. Primary outcomes included vertebral/non-vertebral fracture risk reduction and BMD changes (lumbar spine, femoral neck, hip); secondary outcomes covered BTM variations and adverse events.ResultsEight RCTs (n = 787) were meta-analysed using Review Manager 5.4. Results showed: ① No significant differences in vertebral (OR = 0.93, 95%CI 0.12–6.93) or non-vertebral fractures (OR = 0.68, 0.31–1.46) between groups. ② TPTD combined with denosumab significantly increased lumbar spine (+3.40%, 0.44–6.36), femoral neck (+4.00%, 1.96–6.04), and hip BMD (+4.25%, 3.20–5.29). Bisphosphonate combinations improved hip BMD in the short term (<24 months: +1.81%, 0.65–2.97) but not long-term (≥24 months).③ Combination therapies regulated BTMs bidirectionally: bisphosphonates suppressed P1NP (40%–80% reduction vs. monotherapy), while denosumab preserved OC levels (-8–16% vs. monotherapy).④ Safety profiles were comparable: hypercalcemia incidence (16.3% vs. 14.7%, OR = 1.22, 0.55–2.69), musculoskeletal pain (9.8% overall), with no osteonecrosis cases reported.ConclusionTPTD-denosumab combination is clinically preferable for BMD enhancement, though its long-term (>24 months) fracture risk reduction requires further validation.https://www.frontiersin.org/articles/10.3389/fphar.2025.1605279/fullosteoporosisteriparatide monotherapybisphosphonatesdenosumabvertebral fracturesbone mineral density |
| spellingShingle | Huan Jin Huan Jin Cai Huang Yan Zhang Ying Dong Qi Xiong Di Wang Di Wang Ziyi He Ziyi He Lin Shen Chen Ma Zixian Wang Bo Shuai Comparative efficacy of teriparatide and bisphosphonates or denosumab vs. teriparatide monotherapy in osteoporosis: a meta-analysis Frontiers in Pharmacology osteoporosis teriparatide monotherapy bisphosphonates denosumab vertebral fractures bone mineral density |
| title | Comparative efficacy of teriparatide and bisphosphonates or denosumab vs. teriparatide monotherapy in osteoporosis: a meta-analysis |
| title_full | Comparative efficacy of teriparatide and bisphosphonates or denosumab vs. teriparatide monotherapy in osteoporosis: a meta-analysis |
| title_fullStr | Comparative efficacy of teriparatide and bisphosphonates or denosumab vs. teriparatide monotherapy in osteoporosis: a meta-analysis |
| title_full_unstemmed | Comparative efficacy of teriparatide and bisphosphonates or denosumab vs. teriparatide monotherapy in osteoporosis: a meta-analysis |
| title_short | Comparative efficacy of teriparatide and bisphosphonates or denosumab vs. teriparatide monotherapy in osteoporosis: a meta-analysis |
| title_sort | comparative efficacy of teriparatide and bisphosphonates or denosumab vs teriparatide monotherapy in osteoporosis a meta analysis |
| topic | osteoporosis teriparatide monotherapy bisphosphonates denosumab vertebral fractures bone mineral density |
| url | https://www.frontiersin.org/articles/10.3389/fphar.2025.1605279/full |
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