Four RCTs were included (n=1,867).
Teriparatide versus placebo (one RCT, n=1,637):
Teriparatide was associated with a statistically significant reduction in new vertebral fractures (relative risk 0.35, 95% CI: 0.22 to 0.55 with 20μg and relative risk 0.29, 95% CI: 0.18 to 0.48 with 40μg) and new non-vertebral fractures (relative risk 0.54, 95% CI: 0.37 to 0.79 with 20μg and relative risk 0.5, 95% CI: 0.34 to 0.74 with 40μg).
Teriparatide was associated with a statistically significant increase in whole-body bone mineral density (relative risk 3.1, 95% CI: 1.65 to 4.55 with 20μg and relative risk 4.5, 95% CI: 2.78 to 6.22 with 40μg), lumbar bone mineral density (relative risk 9.6, 95% CI: 7.79 to 9.41 with 20μg and relative risk 12.6, 95% CI: 11.62 to 13.58 with 40μg) and femoral bone mineral density (relative risk 3.6, 95% CI: 2.75 to 4.45 with 20μg and relative risk 4.6, 95% CI: 3.71 to 5.49 with 40μg).
There was no significant difference between teriparatide 20μg and 40μg in whole-body bone mineral density, femoral bone mineral density and rates of treatment withdrawal. Treatment withdrawal was significantly higher with teriparatide 40μg compared to placebo and with teriparatide 40μg compared to 20μg. Headache, nausea cramps, hypercalcaemia and the formation of anti-PTH (parathyroid hormone) antibodies were significantly more common in the teriparatide treatment groups.
Teriparatide versus alendronate (one RCT, n=146):
There was no significant difference between teriparatide and alendronate in the rate of new vertebral or non-vertebral fractures. Teriparatide was associated with an increase in whole-body and lumbar column and femur bone mineral density (results data and the statistical significance of this increase were not reported). The following adverse events were more common in the teriparatide treatment group: cramps; elevated serum and urinary calcium. Alendronate was associated with an increase risk of worsening lumbar pain.
Teriparatide plus oestrogen versus oestrogen (one RCT, n=34): Teriparatide plus oestrogen was associated with significant reduction in new vertebral fractures (relative risk 0.15, 95% CI: 0.03 to 0.73).
Teriparatide plus nafarelin versus nafarelin (one RCT, n=50): Bone mass increased by 3.4% in the teriparatide plus nafarelin group and by 3.5% in the nafarelin only group.