Less Falls in Osteoporosis Patients treated with Teriparatide: A Meta-Analysis

Introduction Falls are a risk factor for osteoporotic fractures and the DVO guidelines recommend to evaluate and decrease the risk of falls in patients with osteoporosis. Therefore, the aim of this meta-analysis was to evaluate the effect of Teriparatide on the risk of falls in patients with osteoporosis. Methods Randomized clinical trials with Teriparatide were systematically searched on Pubmed and clinicaltrials.gov.Trials which met the following criteria, [1] treatment with 20 mu g Teriparatide once daily, [2] randomized trial, [3] study duration of <= 24 months, [4] at least one Teriparatide-free control group, and [5] treatment of patients with osteoporosis and/or glucocorticoid-induced osteoporosis [GIOP], were included into the meta-analysis. Odds ratios (OR) and corresponding 95% confidence intervals (CI) were calculated using a binary effects was model. Results A total of nine trials with 5,822 patients were identified and included into this meta-analysis. Teriparatid was compared in one trial to placebo, in one trial to placebo and abaloparatid, in one trial to Denosumab, in another one to Romosozumab and in five trials to bisphosphonates, respectively. The meta-analysis with all nine trials indicated that Teriparatide reduces the risk of falls statistically significant by 25% (OR: 0.75; 95% CI: 0.56-1.00; p=0.05 n=5,822) compared to control group. A subgroup analysis, stratified by treatment duration, revealed that the risk of falls is consistently lower in patients treated with Teriparatide over <= 12months (OR: 0.52; 95% CI: 0.28-0.96; p=0.04; n=978), 18months (OR: 0.86; 95% CI: 0.591.24; p=0.41; n=3,478) and 24 months (OR: 0.76; 95% CI: 0.39-1.46; p=0.41; n=1,366), respectively. Nevertheless, only the subgroup analysis of the <= 12 months data was statistically significant. A second meta-analysis comparing Teriparatide to bisphosphonates alone, showed a non-significant reduction in risk of falls by Teripratide of 23% (OR: 0.77; 95% CI: 0.55-1.06; p=0.11; n=2,658). The heterogeneity was considered low in both meta-analysis as well as all subgroup analysis with I-2 values of 0% in each case. Conclusion This meta-analysis indicates that Teriparatide has a positive effect on risk of falls in patients with osteoporosis, showing a statistically significant risk reduction. Due to the fact that falls are a risk factor for fractures, guidelines recommend to evaluate the risk of falls in osteoporosis patients and to prevent them from future falls. Therefore, Teriparatide could be an appropriate treatment option for osteoporosis patients with a high risk for falls.