Effects of teriparatide on hip and upper limb fractures in patients with osteoporosis : A systematic review and meta-analysis
Díez Pérez, Adolfo (Institut Hospital del Mar d'Investigacions Mèdiques)
Marin, Fernando (Lilly Research Center, Windlesham, United Kingdom)
Eriksen, Erik F. (Oslo University Hospital (Oslo, Noruega))
Kendler, David L. (University of British Columbia, Vancouver, Canada)
Krege, John H. (Lilly Research Laboratories, Indianapolis, USA)
Delgado-Rodríguez, Miguel (Universidad de Jaén)
Universitat Autònoma de Barcelona

Fecha:	2019
Resumen:	In randomized clinical trials (RCTs) with teriparatide, the number of patients with incident hip fractures was small and insufficiently powered to show statistically significant differences between groups. We, therefore, conducted a systematic review and meta-analysis of the efficacy of teriparatide in the reduction of hip and upper limb fractures in women and men with osteoporosis. A comprehensive search of databases until 22 November 2017 was conducted for RCTs of at least 6-month duration that reported non-spine fractures (hip, humerus, forearm, wrist), either as an efficacy or safety endpoint. Only RCTs that included patients with the approved treatment indications and dose for use of teriparatide were included; trials with off-label use of teriparatide were excluded. Two independent reviewers performed study selection and data extraction. 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. Study results are expressed as odds ratios (OR) with 95% confidence intervals (CI). Publication bias and heterogeneity were evaluated with standard statistical tests. Twenty-three RCTs were included, 19 with an active-controlled arm (representing 64. 9% of the patients included in the control group) and 11 double-blind, representing data on 8644 subjects, 3893 of them treated with teriparatide. Mean age (SD) was 67. 0 (4. 5) years, median treatment duration 18 months (range: 6 to 24 months). A total of 34 incident hip, 31 humerus, 31 forearm, and 62 wrist fractures were included. Meta-analysis 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. The effects on the risk of humerus [1. 02 (0. 50-2. 08)], forearm [0. 53 (0. 26-1. 08)] and wrist fractures [1. 21 (0. 72-2. 04)] were not statistically significant (p > 0. 05). This meta-analysis provides evidence of efficacy of teriparatide in reducing hip fractures by 56% in patients with osteoporosis.
Derechos:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Lengua:	Anglès
Documento:	Article de revisió ; Article ; Versió publicada
Materia:	Fractures ; Hip fracture ; Meta-analysis ; Systematic review ; Teriparatide
Publicado en:	Bone, Vol. 120 (march 2019) , p. 1-8, ISSN 8756-3282

DOI: 10.1016/j.bone.2018.09.020
PMID: 30268814

8 p, 1.2 MB

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