Although bisphosphonates have traditionally been the cornerstone of pharmacological management of bone protection in patients, new evidence suggests that teriparatide and denosumab merit further investigation as potential first-line treatments. The optimal choice between denosumab, teriparatide and oral bisphosphonates for the treatment of postmenopausal osteoporosis remains a subject of debate and controversy within the scientific community.
This systematic review meticulously adhered to the rigorous standards described in the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines, as well as to the recommendations of the Cochrane Collaboration. In addition, the AMSTAR criteria (Assessing the methodological quality of systematic reviews) were used to ensure methodological robustness and improve the credibility of the results. A systematic electronic search was carried out in the Web of Science, PubMed and Cochrane Library databases from their creation until February 2024.
In this meta-analysis of studies, the results suggest that, compared with bisphosphonates, both teriparatide and denosumab demonstrated significant increases in percentage changes in lumbar spine bone mineral density (BMD) in postmenopausal patients with osteoporosis. In addition, denosumab showed superiority over teriparatide and oral bisphosphonates in increasing percentage changes in femoral neck and total hip BMD, indicating that it may be a more effective option.
In terms of safety endpoints, there was no significant difference in the incidence of serious adverse events in patients treated with teriparatide, denosumab and bisphosphonates. However, teriparatide showed superiority over oral bisphosphonates in terms of lower risk of systemic adverse events, suggesting a favourable safety profile.
In conclusion, this study suggests that teriparatide and denosumab have comparable or potentially superior efficacy and safety profiles to oral bisphosphonates for the treatment of postmenopausal osteoporosis.
