Dec 5, 2022
Osteoporosis after the menopause: fewer vertebral fractures with teriparatide than with risedronate
IQWiG's final report on the comparative benefit assessment of bisphosphonates, teriparatide and denosumab now available in English. No change in results between the preliminary and final report.
Medication for women with postmenopausal osteoporosis usually includes drugs that prevent bone loss (including bisphosphonates such as risedronate and monoclonal antibodies such as denosumab) or drugs that stimulate the formation of new bone (including teriparatide).
To answer the question as to which of these treatment options is the most promising, the Institute for Quality and Efficiency in Health Care (IQWiG) conducted a comparative benefit assessment of bisphosphonates, denosumab and teriparatide on behalf of the Federal Joint Committee (G-BA). The English translation of the final report is now available.
IQWiG had originally planned to conduct a network meta-analysis for the benefit assessment in order to be able to compare drugs even in situations where there are no direct comparative studies. However, there were not enough data to create a complete network of all drugs. The Institute therefore looked at individual comparisons: denosumab versus bisphosphonates, teriparatide versus risedronate, and bisphosphonates compared with each other.
Only the comparison between teriparatide and risedronate showed differences between the treatment groups: women treated with teriparatide had markedly fewer vertebral fractures than those treated with risedronate. The fact that digestive problems were slightly more common with teriparatide played a minor role in the overall weighing of benefits and harms. IQWiG therefore concluded that, overall, teriparatide had advantages over risedronate.
Procedure of report production
In January 2019, the G-BA commissioned IQWiG to assess bisphosphonates, teriparatide and denosumab for the treatment of postmenopausal osteoporosis. IQWiG published the preliminary results in the form of a preliminary report in June 2022 and invited interested parties to submit comments.
At the end of the commenting procedure, the report was revised and sent as a final report to the contracting agency, the G-BA, in November 2022. The written comments submitted were published in a separate document at the same time as the final report in December 2022.
An external expert was involved in the work on the project.