Effects Of Teriparatide Versus Salmon Calcitonin Therapy For The Treatment Of Osteoporosis In Asia:A Meta-analysis

Objective:Osteoporosis is associated with microarchitectural deterioration and increased risk of fracture.Teriparatide is an anabolic drug and salmon calcitonin is an antiresorptive agent;both are used in the treatment of osteoporosis.However,comprehensive studies comparing the safety and efficacy of teriparatide with salmon calcitonin are scarce,and data on Asian populations are even rarer.Therefore,we use the method of system evaluation,conducting a comprehensive retrieval and evaluation of Randomized controlled trial(RCT)comparing teriparatide and salmon calcitonin in the treatment of osteoporosis in Asian patients,so as to further understand and clarify the efficacy and safety of teriparatide vs.salmon calcitonin in the treatment of osteoporosis in Asian population.Methods:Literatures in PubMed、OVID.、Cochrane Central Register of Controlled Trials(Central)and EMBASE database were retrieved(Literature search is limited to English),manual retrieval data and conference papers have been published in English;Online retrieval Clinical Trials.gov(http://clinicaltrials.gov)to find the unpublished literatures.Collect all relevant randomized controlled trials,using the Cochrane Collaboration software Review Manager 5.3 to obtain the relevant evidence of the efficacy and safety of teriparatide vs.salmon calcitonin in the treatment of osteoporosis in Asian population.Results:Three studies and 529 patients were included.All of the three RCTs were at unclear risk of bias for sequence generation.All the RCTs were at unclear risk for allocation concealment.Only one trial was at unclear risk of blinding of participants and personnel,while other trials were at low risk of blinding.Meta-analysis results suggested that at the observed end point of 6 months,the teriparatide group was compared with the salmon calcitonin group in the treatment of osteoporosis in Asian populations,percentage change of BMD in the lumbar spine was[MD = 4.37,95%ci = 4.13-4.60,P<0.00001];Percentage change in total hip BMD was[MD =-0.0,95%CI =-0.48-0.48,P = 0.99];Percentage change in femoral neck BMD was[MD =-0.05,95%CI=-1.87 to-1.77,P = 0.96];Percentage change in bone-specific alkaline phosphatase(BASP)at 3 months was[MD = 49.19,95%CI = 45.03 to 53.35,P<0.00001];percentage change of bone specific alkaline phosphatase(BASP)at 6 months was[SMD = 7.84,95%Cl = 2.18 to 13.49,P = 0.007];Percentage change in osteocalcin(OCN)at 3 months was[SMD= 13.49,95%CI = 8.10 to 18.87,P<0.00001];Percentage change in osteocalcin(OCN)at 6 months was[SMD = 13.49,95%CI = 8.10 to 18.87,P<0.00001]was[SMD = 7.43,95%CI = 3.63 to 11.23,P = 0.0001];The occurrence of adverse events was[OR=1.19,95%CI= 0.57 to 2.50,P =0.64].For Asia patients with osteoporosis,teriparatide increased BMD in the lumbar spine more significantly than salmon calcitonin at 6 months of treatment,but was less effective in improving BMD in the femoral neck and total hip joint.Teriparatide is more effective than salmon calcitonin in the treatment of osteoporosis in Asian populations.In addition,BSAP and OCN,as markers reflecting the activity and bone formation of osteoblasts,may be associated with the response of Asian people to teriparatide.With the increase of the treatment time of teriparatide,the activity of osteoblasts can be continuously promoted during the course of medication.On the other hand,there was no statistical difference in the incidence of adverse reactions between teriparatide and salmon calcitonin,but gender factors may affect the population’s response to teriparatide.Conclusions:In the treatment of Asian osteoporosis patients,the 6-month treatment time is helpful for the improvement of the BMD of lumbar vertebra,but the effect is not efficient for the increase of femoral neck and total hip joint,even resulting in the decrease of the BMD of them.Therefore,the longer course of teriparatide treatment may be more recommended clinically;And there may be a positive correlation between BSAP and OCN and the response of Asian patients to teriparatide,a bone-forming drug,with subcutaneous injection of 20 micrograms of per day;Since there was no significant difference in the incidence of adverse reactions between the two groups,it is recommended to use teriparatide for improving lumbar BMD in Asian osteoporosis patients,especially those with a short course of treatment,and a longer course of treatment may be more effective in improving BMD of femoral neck and total hip joint.Abbreviations:BMD = bone mineral density,BSAP = bone-specific alkaline phosphatase,OC = osteocalcin,PTH = parathyroid hormone,CI = confidence interval,OR = odds ratio,RCTs = randomized controlled trials,MD = Mean difference.