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Fracture Apparatus Design and Protocol Optimization for Closed-stabilized Fractures in Rodents
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PTH1 receptor agonists for fracture risk: a systematic review and network meta-analysis.

Charlotte Beaudart1,2, Nicola Veronese3,4, Jonathan Douxfils5,6,7

  • 1World Health Organization (WHO) Collaborating Center for Epidemiology of Musculoskeletal Health and Ageing, University of Liège, Liège, Belgium. charlotte.beaudart@unamur.be.

Osteoporosis International : a Journal Established As Result of Cooperation Between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA
|March 6, 2025
PubMed
Summary

Parathyroid hormone (PTH) analogs, teriparatide and abaloparatide, effectively reduce fracture risk in osteoporosis patients. Abaloparatide shows greater efficacy for non-vertebral and hip fractures compared to teriparatide, with both agents demonstrating favorable safety profiles.

Keywords:
AbaloparatideFracturesMACENetwork meta-analysisOsteoporosisPTH-1 receptor agonistsRandomized controlled trialsReal-world evidence studiesSafetyTeriparatide

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Area of Science:

  • Endocrinology and Bone Metabolism
  • Pharmacological Interventions for Osteoporosis

Background:

  • Osteoporosis is characterized by decreased bone mineral density and deteriorating bone structure, increasing fracture risk, especially in aging individuals.
  • Randomized controlled trials (RCTs) confirm the efficacy of parathyroid hormone type 1 (PTH1) receptor agonists, teriparatide and abaloparatide, in reducing fractures, but real-world evidence (RWE) is limited.

Purpose of the Study:

  • To systematically review and compare the anti-fracture efficacy of teriparatide and abaloparatide against each other and other osteoporosis treatments.
  • To evaluate the efficacy using both randomized controlled trials (RCTs) and real-world evidence (RWE).
  • To assess the safety profiles of these agents.

Main Methods:

  • Systematic literature search of Medline, Embase, and Cochrane databases up to May 2024 for RCTs and RWE studies.
  • Inclusion criteria focused on studies reporting fracture reduction (vertebral, non-vertebral, hip, or all) as a primary endpoint.
  • Network meta-analysis (NMA) including pairwise meta-analyses and Bayesian NMA; safety assessment using MedDRA adverse event classification.

Main Results:

  • Both teriparatide and abaloparatide significantly reduced vertebral and non-vertebral fractures compared to placebo.
  • Abaloparatide demonstrated superior efficacy over teriparatide for non-vertebral fractures (OR: 0.87) and hip fractures (OR: 0.81).
  • In NMA, both PTH1 analogs outperformed placebo, raloxifene, and calcitonin for vertebral fractures; teriparatide also surpassed denosumab and risedronate. Abaloparatide was superior for non-vertebral fractures, while teriparatide showed superiority only over alendronate or placebo.

Conclusions:

  • PTH1 receptor agonists are effective in reducing fracture risk, with abaloparatide showing enhanced benefits for non-vertebral and hip fractures compared to teriparatide.
  • Both agents possess comparable safety profiles to other osteoporosis treatments, with no increased cardiovascular risk.
  • Teriparatide and abaloparatide represent valuable therapeutic options for managing osteoporosis, particularly in high-risk patient populations.