title: Indirect comparison of teriparatide, denosumab, and oral bisphosphonates for the prevention of vertebral and nonvertebral fractures in postmenopausal women with osteoporosis.
abstract: OBJECTIVE
  This study aims to compare the efficacy of teriparatide, denosumab, and oral bisphosphonates for reducing fracture risk in postmenopausal women with osteoporosis.
  
  
  METHODS
  We searched the literature, via PubMed, Medline, Embase, and the Cochrane Library, to screen citations from January 1996 to October 2014 for inclusion in this study. A mixed-treatment comparison meta-analysis within a Bayesian framework was performed by WinBUGS version 1.4.3 software. The proportions of women with vertebral fractures and women with nonvertebral fractures were analyzed.
  
  
  RESULTS
  Our meta-analysis results indicated that all of the therapies-except etidronate-achieved a statistically significant reduction of fractures compared with placebo. Teriparatide and denosumab were more effective than alendronate and risedronate for reducing vertebral fracture (teriparatide vs alendronate: odds ratio [OR], 1.76; 95% CI, 1.03-2.98; teriparatide vs risedronate: OR, 1.92; 95% CI, 1.13-3.19; denosumab vs alendronate: OR, 1.67; 95% CI, 1.06-2.67; denosumab vs risedronate: OR, 1.84; 95% CI, 1.16-2.92). Teriparatide, denosumab, alendronate, and risedronate also reduced the risk of nonvertebral fracture compared with placebo. Results of subgroup analysis showed that denosumab (OR, 0.6; 95% CI, 0.37-0.98), alendronate (OR, 0.61; 95% CI, 0.39-0.96), and risedronate (OR, 0.63; 95% CI, 0.46-0.86) can reduce the risk of hip fracture and that risedronate (OR, 0.59; 95% CI, 0.4-0.88) can also reduce the risk of upper-arm fracture.
  
  
  CONCLUSIONS
  Teriparatide, denosumab, alendronate, and risedronate are effective in reducing the risk of vertebral and nonvertebral fractures in postmenopausal women with osteoporosis. Furthermore, denosumab, alendronate, and risedronate can reduce the risk of hip fracture, and risedronate can also reduce the risk of upper-arm fracture.
authors.affiliation: Department of Rheumatology and Immunology, Changhai Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Lanling
authors.initials: L
authors.lastname: Zhang
authors.forename: Yafei
authors.initials: Y
authors.lastname: Pang
authors.forename: Yeqing
authors.initials: Y
authors.lastname: Shi
authors.forename: Meijuan
authors.initials: M
authors.lastname: Xu
authors.forename: Xia
authors.initials: X
authors.lastname: Xu
authors.forename: Ju
authors.initials: J
authors.lastname: Zhang
authors.forename: Lianmei
authors.initials: L
authors.lastname: Ji
authors.forename: Dongbao
authors.initials: D
authors.lastname: Zhao
mesh_terms: D000284:Administration, Oral; D050071:Bone Density Conservation Agents / Q000008:administration & dosage; D000069448:Denosumab / Q000008:administration & dosage; D004164:Diphosphonates / Q000008:administration & dosage; D005260:Female; D006801:Humans; D015663:Osteoporosis, Postmenopausal; D058866:Osteoporotic Fractures / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic; D013124:Spinal Injuries / Q000517:prevention & control*; D019379:Teriparatide / Q000008:administration & dosage
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D019379:Teriparatide; D000069448:Denosumab