Fractures, especially subsequent ones, positively correlate with an increased mortality risk.
Caucasian, postmenopausal women make up the highest percentage of patients who experience osteoporosis-related vertebral (74.4%) and nonvertebral (72.8%) fractures.1 Fractures, especially subsequent ones, positively correlate with an increased mortality risk.2
Although many studies have shown bone mineral density increases more with teriparatide compared to bisphosphonates, only 1 study, the VERO trial (NCT01709110), directly compares fracture incidence.3
A recent article, published in the journal Medicine, compares the efficacy of teriparatide and bisphosphonates in fracture prevention in postmenopausal women with osteoporosis.3
The authors conducted a meta-analysis, pooling data from 9 different randomized controlled trials, including the VERO trial. Ouyang et al. assessed the incidence of new vertebral and non-vertebral (e.g., hip, arm) fractures in the 2 study arms.3
Overall, the analysis results support that teriparatide was better than bisphosphonates in preventing both fracture types, vertebral and nonvertebral, in postmenopausal women with osteoporosis (fracture risk not specified). These results reflect data collected at both 12- and 18-month follow-up visits.3
Women taking teriparatide did not experience more adverse events (eg, arthralgia, back pain, hyperuricemia) compared to bisphosphonates.3
Two obvious limitations exist for teriparatide use4:
Oral and intravenous bisphosphonates are less expensive (AWP: ~$150) and administered anywhere from once per week to once per year.4
The 2020 American Association of Clinical Endocrinologists & American College of Endocrinology and 2020 Endocrine Society guidelines contain a treatment algorithm based on fracture risk and history. Currently, teriparatide is only first-line therapy in postmenopausal osteoporotic women with very high fracture risk and/or prior fracture history. Bisphosphonates are first-line in women with high risk and/or no prior fractures and are an alternative treatment to teriparatide.5-7
Despite the positive study findings, the authors concluded a cost-benefit analysis and further studies are necessary to determine what place teriparatide truly has in treatment guidelines.3
Justyna Sudyka is a 2021 PharmD Candidate at the University of Connecticut in Storrs.