Romosozumab Versus Teriparatide for the Treatment of Postmenopausal Osteoporosis: An Overview of Systematic Reviews With Direct and Indirect Meta-Analyses
Abstract
Aim: To summarize the evidence of efficacy and safety of romosozumab compared to teriparatide for postmenopausal osteoporosis.
Methods: A literature search was performed in Medline, the Cochrane Library, CRD, and LILACS until November 2023. We included systematic reviews with meta-analyses on the use of romosozumab compared to teriparatide in women with postmenopausal osteoporosis. Two authors performed study selection, data extraction, and quality assessment using AMSTAR-2 and GRADE tools.
Results: A total of 725 records were identified, and 13 studies fully met the eligibility criteria. Regarding efficacy, romosozumab did not show a significant difference in risk of falls (12/24 months), vertebral fractures (12/36 months), non-vertebral fractures (12/36 months), and hip fractures compared to teriparatide. For the safety profile, romosozumab did not show significant change compared to teriparatide for serious adverse events (12/26 months) and composite cardiovascular outcomes (3PMACE and 4PMACE). The overall quality of evidence in the reviews ranged from very low to moderate, primarily due to indirectness and imprecision in the outcomes. Additionally, the reviews were classified as having "low" or "critically low" methodological quality.
Conclusion: Romosozumab demonstrated efficacy and safety similar to teriparatide. However, this overview revealed substantial overlap among primary studies, with most outcomes assessed through indirect comparisons and poor methodological…
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Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid.
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