Comparative efficacy of bone anabolic therapies in women with postmenopausal osteoporosis: A systematic review and network meta-analysis of randomized controlled trials. (November 2019)

• Record Type: Journal Article
• Authors: Hernandez, Adrian V.; Pérez-López, Faustino R.; Piscoya, Alejandro; Pasupuleti, Vinay; Roman, Yuani M.; Thota, Priyaleela; Herrera, Antonio
• Is Part Of: Maturitas. Volume 129(2019)
• Page Start: 12
• Page End: 22
• Publication Date: 2019-11
• Subjects: 95%CIs 95% confidence interval -- AP alkaline phosphatase -- BAT bone anabolic therapy -- BMD bone mineral density -- BMI body mass index -- CTX C-terminal telopeptide of type I collagen -- DEXA dual energy X-ray absorptiometry -- HRT hormone replacement therapy -- IU international unit -- MD mean difference -- NMA network meta-analysis -- NTX crosslinked N-telopeptide of type I collagen -- PINP N-terminal propeptide of type I procollagen -- PRISMA Preferred Reporting Items of Systematic Reviews and Meta-analyses -- PTH parathyroid hormone -- RCT randomized controlled trial -- RR risk ratio -- SAE severe adverse event -- SC subcutaneous -- SERM Selective estrogen receptor modulator; Postmenopausal osteoporosis -- Fractures -- Bone -- Anabolic therapy -- Abaloparatide -- Romosozumab -- Teriparatide; Climacteric -- Periodicals; Menopause -- Periodicals; Climacteric -- Periodicals; Geriatrics -- Periodicals; Menopause -- Periodicals; Middle Aged -- Periodicals; Climatère -- Périodiques; Ménopause -- Périodiques; Climacterium; Climacteric; Menopause; Electronic journals; Periodicals; 612.66
• DOI: 10.1016/j.maturitas.2019.08.003
• Languages: English
• ISSNs: 0378-5122

Abstract

Highlights: Bone anabolic therapies (BATs) include teriparatide, abaloparatide and romosozumab. All bone anabolic therapies significantly increase bone mineral density at all locations. All bone anabolic therapies reduce the risk of vertebral fractures. No intervention significantly reduces the risk of non-vertebral fractures. Abstract: Objective: To systematically evaluate the effects of bone anabolic therapies (BATs) – specifically, drug therapy with teriparatide, abaloparatide or romosozumab – on fractures, bone mineral density (BMD), and bone metabolites in postmenopausal osteoporosis. Methods: Six computerized engines were searched through to November 2018. We selected randomized controlled trials (RCTs) evaluating the effect of BATs on postmenopausal osteoporosis and with at least 6 months of follow-up. Controls were placebo, no treatment, or bisphosphonates. Primary outcomes were vertebral and non-vertebral fractures. Secondary outcomes were: BMD determined by dual energy X-ray absorptiometry at total hip, lumbar spine, and femoral neck; N-terminal propeptide of type I procollagen (PINP); C-terminal telopeptide of type I collagen (CTX); and severe adverse events (SAE). We followed the PRISMA guidelines for reporting, and used version 2 of the Cochrane risk-of-bias tool. Frequentist network meta-analyses were performed per outcome. Effects for dichotomous and continuous outcomes were expressed as relative risks and mean differences and their 95% confidence intervals. We used p-scores to rank best treatments per outcome. Results: Sixteen RCTs (n = 18, 940) were evaluated. Mean ages ranged between 61 and 74 years, and follow-up times between 6 and 30 months. Four RCTs (n = 971) excluded patients with previous fractures. In contrast to placebo/no treatment, all BATs significantly reduced the risk of vertebral fractures, but no intervention significantly reduced the risk of non-vertebral fractures; abaloparatide ranked better than other interventions for both fracture types (p-scores: 0.95, and 0.89, respectively). All BATs significantly increased BMD at all locations in comparison with placebo/no treatment; romosozumab consistently ranked better than other interventions at all BMD locations (p-scores >0.86). Teriparatide ranked better than other interventions for increasing PINP. No differences in SAE were observed among treatments. Conclusions: Abaloparatide, romosozumab, and teriparatide are the best treatments, respectively, to reduce vertebral/non-vertebral fractures, increase BMD, and increase bone formation.