title: Understanding and communicating the benefits and risks of denosumab, raloxifene, and teriparatide for the treatment of osteoporosis.
abstract: The number needed to treat is a valuable metric to determine the benefit of therapy, but it must be viewed against the respective number needed to harm. Denosumab and teriparatide (TPTD) have proven antifracture efficacy at vertebral and nonvertebral sites, whereas raloxifene has proven antifracture efficacy at the spine only. Denosumab use has been associated with a small, yet statistically significant, increased incidence of eczema and serious cellulitis. Raloxifene use has been associated with statistically significant increases in the risk of venous thromboembolism and possibly deadly stroke, although not an increase in total strokes. No significant, nontransient adverse events have been reported with TPTD use. When used for the treatment of postmenopausal osteoporosis, denosumab, raloxifene, and TPTD all generally have favorable risk-to-benefit profiles, but therapy-specific contraindications necessitate thoughtful consideration of all available clinical information and individualization of treatment decisions.
authors.affiliation: New Mexico Clinical Research and Osteoporosis Center, Albuquerque, NM, USA. Electronic address: mlewiecki@gmail.com.
authors.forename: E Michael
authors.initials: EM
authors.lastname: Lewiecki
authors.affiliation: Colorado Center for Bone Research, Lakewood, CO, USA.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Miller
authors.affiliation: Department of General Internal Medicine, University of California, San Francisco, CA, USA.
authors.forename: Steve T
authors.initials: ST
authors.lastname: Harris
authors.affiliation: Department of General Internal Medicine, University of California, San Francisco, CA, USA.
authors.forename: Douglas C
authors.initials: DC
authors.lastname: Bauer
authors.affiliation: Faculty of Graduate Studies, University of Victoria, British Columbia, Canada.
authors.forename: K Shawn
authors.initials: KS
authors.lastname: Davison
authors.affiliation: Prohealth Clinical Research, University of British Columbia, Vancouver Canada.
authors.forename: Larry
authors.initials: L
authors.lastname: Dian
authors.affiliation: Department of Medicine, University of Calgary, Calgary, Canada.
authors.forename: David A
authors.initials: DA
authors.lastname: Hanley
authors.affiliation: Oregon Osteoporosis Center, Portland, OR, USA.
authors.forename: Michael R
authors.initials: MR
authors.lastname: McClung
authors.affiliation: Prohealth Clinical Research, University of British Columbia, Vancouver Canada.
authors.forename: Chui K
authors.initials: CK
authors.lastname: Yuen
authors.affiliation: Prohealth Clinical Research, University of British Columbia, Vancouver Canada.
authors.forename: David L
authors.initials: DL
authors.lastname: Kendler
mesh_terms: D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects / Q000627:therapeutic use*; D050071:Bone Density Conservation Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000069448:Denosumab; D005260:Female; D006801:Humans; D015663:Osteoporosis, Postmenopausal / Q000188:drug therapy*; D058866:Osteoporotic Fractures / Q000517:prevention & control*; D010353:Patient Education as Topic; D010817:Physician-Patient Relations; D020849:Raloxifene Hydrochloride / Q000009:adverse effects / Q000627:therapeutic use*; D018570:Risk Assessment; D019379:Teriparatide / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D050071:Bone Density Conservation Agents; D019379:Teriparatide; D000069448:Denosumab; D020849:Raloxifene Hydrochloride
keywords: Benefit; fracture; osteoporosis; risk; treatment