Prevention of vertebral fractures in primary osteoporosis with once-weekly teriparatide: A systematic review and meta-analysis of randomized controlled trials

Aims: The present meta-analysis was undertaken to summarize the data from hitherto available randomized controlled trials (RCTs) on the prevention of incident fractures in patients with primary osteoporosis following the use of once-weekly teriparatide. Methods: PubMed/MEDLINE, Web of Science, and Google Scholar databases were systematically searched till May 21, 2021, to identify RCTs with duration ≥72 weeks, evaluating the efficacy of once-weekly teriparatide (at a dose of 56.5 μg/week or 28.2 μg/week) in the prevention of incident fractures as compared to placebo or active comparator. Results: We identified 3 eligible RCTs, pooling data retrieved from 1643 participants with primary osteoporosis. Pooled data showed that the risk of incident morphometric vertebral fractures was significantly lower with once-weekly teriparatide compared to placebo/active comparator (RR 0.33, 95% confidence intervals [CI]: 0.12,0.90, P = 0.03; I2 = 86%). Sensitivity analysis after exclusion of the study where an active comparator had been used instead of placebo also showed a similar result (RR 0.20, 95% CI: 0.11,0.37, P < 0.00001; I2 = 0%). Data on clinical vertebral fractures or nonvertebral fractures were inadequately reported across the RCTs and hence could not be pooled together. Nevertheless, all the RCTs did not find any significant difference in the risk of incident nonvertebral fractures. Conclusions: The present systematic review and meta-analysis show that once-weekly teriparatide leads to a 67% reduction in the risk of incident morphometric vertebral fractures. Considering the reasonable efficacy, once-weekly dose, and reduced cost, the formulation can be an important antiosteoporotic drug, especially in resource-constraint settings, like India.