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Clinical Application of Teriparatide in Fracture Prevention

A Systematic Review

Chen, Yuehong, MD1,2; Liu, Ronghan, MD1; Hettinghouse, Aubryanna, BS1; Wang, Shuya, MD1; Liu, Gang, PhD2; Liu, Chuan-ju, PhD1,3

doi: 10.2106/JBJS.RVW.18.00052
Evidence-Based Systematic Reviews
Supplementary Content

Background: Teriparatide, a 1-34 fragment of parathyroid hormone (PTH) that maintains most of the biological activities of PTH, has been employed since 2002 as an anabolic agent for osteoporotic individuals who are at high risk of fracture. The purpose of the present review is to provide a systematic summary and timely update on treatment with teriparatide for fracture prevention.

Methods: Electronic databases, including OVID MEDLINE, OVID Embase, and the Cochrane Library, were searched on February 9, 2018, to identify published systematic reviews and meta-analyses addressing treatment with teriparatide for fracture prevention, and A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2) was used to assess the quality of included studies.

Results: Seventeen studies were included. Of the 17 eligible studies, 3 were rated as high quality, 3 were rated as moderate quality, 6 were rated as low quality, and 5 were rated as critically low quality. Teriparatide reduced vertebral and overall nonvertebral fractures in osteoporotic patients regardless of the existence of precipitating conditions, including postmenopausal status, glucocorticoid treatment, and chronic kidney disease, as compared with placebo, but not the site-specific nonvertebral fractures of the wrist and hip. Teriparatide did not more effectively reduce fracture risks when compared with other medications, such as bisphosphonates, selective estrogen receptor modulators, RANKL (receptor activator of nuclear factor kappa-beta ligand) inhibitor, or strontium ranelate.

Conclusions: Teriparatide was safe and was not associated with an increased rate of adverse events when compared with other drugs. Teriparatide was effective for the prevention of vertebral and overall nonvertebral fractures in osteoporotic patients but not for the prevention of site-specific nonvertebral fractures at the wrist and hip.

Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

1Department of Orthopaedic Surgery, New York University Medical Center, New York, NY

2Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China

3Department of Cell Biology, New York University School of Medicine, New York, NY

E-mail address for C.-j. Liu:

Investigation performed at the Department of Orthopaedic Surgery, New York University Medical Center, New York, NY

Disclosure: This work was supported by National Institutes of Health (NIH) research grants 1R01NS103931, R01AR062207, and R01AR061484, and Department of Defense (DOD) research grant W81XWH-16-1-0482. Yuehong Chen was funded by the China Scholarship Council (grant number 201606240021). The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (

Copyright © 2019 by The Journal of Bone and Joint Surgery, Incorporated
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