Clinical Compared with placebo, teriparatide 20 micrograms administered daily by subcutaneous injection confers a significant reduction in the risk of vertebral and non-vertebral fractures as secondary prevention.
Teriparatide 40 micrograms daily and alendronate 10 mg daily are not significantly different in the secondary prevention of non-vertebral fractures. . Teriparatide 20 micrograms per day, the recommended dose, has not been compared in head-to-head fracture trials with any bisphosphonate.
No trials with teriparatide studied the primary prevention of osteoporotic fractures in women.
Limited evidence support the use of bisphosphonates in the primary prevention of osteoporotic fractures. Only alendronate has been shown to be effective in primary prevention, and this effect is limited to vertebral fractures.
Compared with placebo, etidronate is effective in the secondary prevention of vertebral fractures.
Compared with placebo, alendronate is effective in the secondary prevention of vertebral, non-vertebral, hip, and wrist fractures.
Compared with placebo, risedronate is effective in the secondary prevention of vertebral, nonvertebral, and hip fractures.
Economic Alendronate or no drug therapy is the optimal treatment option. The choice between the two depends on the woman1s age (i.e., alendronate is more cost-effective for women > or = 80 years because of an increase in the baseline risk of fracture), and the maximum willingness of decision makers to pay for a QALY gained (e.g., ICER of C$169,600 for alendronate versus no drug therapy among women 65 years of age).
Teriparatide is not cost-effective compared to bisphosphonates under any scenario.
If no drug therapy is the only available alternative, then teriparatide in an 80-year-old woman with a previous fracture is cost-effective if the health care system is prepared to pay C$851,000 for a QALY.
Etidronate was dominated by alendronate in all age groups.
It is estimated that by 2006, if teriparatide were listed as a limited use benefit on publicly funded drug plans, governments could incur C$115 million to C$230 million in additional drug costs, depending on the utilization, and the number of patients treated.