Comparative Effectiveness and Safety of Abaloparatide and Teriparatide in the Treatment of Osteoporosis in Postmenopausal Women: A Systematic Review and Meta-Analysis

OBJECTIVES: Abaloparatide, a novel synthetic analogue of human parathyroid hormone-related peptide, appears to have better efficacy and safety than teriparatide, which has the same mechanism of action. The objective of this study was to conduct a systematic review and meta-analysis to evaluate the effectiveness and safety of abaloparatide and teriparatide in treating osteoporosis in postmenopausal women.

METHODS: PubMed, Embase, Cochorane library, ClinicalTrials.gov databases were searched from database inception to April 2023. Review Manager 5.4 was applied to perform the meta-analysis and random-effects models were used to derive pooled estimates. Randomized controlled clinical trials and observational studies were assessed using the Cochrane Risk of Bias Tool and the Newcastle-Ottawa Scale, respectively.

RESULTS: Two studies (N=24,874) were included, one was an international multicenter clinical trial and the other was an observational study. Compared with teriparatide, abaloparatide had no significant difference in reduction of non-vertebral fractures (pooled hazard ratio (pHR)=0.88, 95%confidence intervals (CI): 0.77-1.02, I²=0%), major adverse cardiovascular events (MACE) (pHR=1.00, 95%CI: 0.84-1.19, I²=0%), MACE + heart failure (HF) (pHR=1.05, 95%CI: 0.93-1.19, I²=0%).

CONCLUSIONS: The findings suggest that abaloparatide is not significantly different from teriparatide in reducing non-vertebral fracture and cardiovascular safety in postmenopausal women with osteoporosis. However, due to the lack of head-to-head studies comparing abaloparatide and teriparatide, further research is needed to evaluate the comparative effectiveness of the two treatments on other important outcomes including vertebral and hip fractures.