Effekterna av alendronat, denosumab och teriparatid på frakturrisk och bentäthet hos postmenopausala kvinnor med osteoporos

Sammanfattning: Background Osteoporosis is a disease with reduced bone mass and deterioration of bone structure, which leads to increased risk of fractures (1.9). Approximately one in four men and one in two women will at some time in life suffer a fracture due to osteoporosis. Supplemental calcium and vitamin D have long been a cornerstone of osteoporosis treatment. Drugs that are also used clinically for the treatment of osteoporosis include bisphosphonates, denosumab, selective estrogen receptor modulators (SERM), and strontium (3). Bisphosphonates are the most used osteoporosis drugs (4). The bisphosphonates alendronate, risedronate and zoledronic acid are interchangeable as first choice treatment of osteoporosis in postmenopausal women. Denosumab is another drug with antiresorptive effects that has been registered for the treatment of postmenopausal osteoporosis in recent years. Teriparatide (PTH) is an anabolic drug used for osteoporosis (3.6). Objective: The objective of this study was to examine the efficacy of alendronate, denosumab and teriparatide on fracture risk and bone mineral density in postmenopausal women with osteoporosis with the help of published meta-analyses and clinical trials. Result: Examined articles showed that alendronate treatment for at least one year reduces the risk of vertebral fractures with NNT = 17-50 and the risk of non-vertebral fractures with NNT = 50. PTH reduced the risk of vertebral fractures with NNT = 9.8 and non-vertebral fractures with NNT = 29. A statistically significant increase in BMD was also observed with an increase in BMD of 8.14% in the spine and 2.48% in the hip. PTH treatment compared with alendronate treatment was found to have a statistically significant difference (P=0.004) in the reduction of non-vertebral fracture risk with NNT = 10,4. Teriparatid treatment also showed more positive effects as compared to alendronate on BMD increases. Denosumab treatment for 36 months reduced the risk of fractures with a relative reduction of 68% for vertebral fractures and a relative reduction of 20% for non-vertebral fractures. Denosumab treatment for 12 months compared with alendronate therapy in postmeopausala women showed no statistically significant difference in fracture risk (p=0,19). The increase in BMD was, however, greater in the denosumab group than in the alendronate group, with 0.53% in the distal radius, 1.14% in the hip , 0.77% in the lumbar spine and 0.79% in the femoral neck.   Conclusion: These studies show that all three drugs, alendronate, PTH and denosumab, have good effects on reducing the risk of fractures in postmenopausal women. All drugs lead to increases in BMD in different parts of the skeleton. Reduction of fracture risk was greater for both denosumab treatment and PTH treatment compared to alendronate treatment, also BMD increased more with denosumab or PTH treatment compared with alendronate treatment.