Treatment with abaloparatide reduces the risk for vertebral, nonvertebral, and wrist fractures in postmenopausal women with osteoporosis compared with placebo or other medical treatments, according to study results published in Osteoporosis International.

The researchers noted that in light of the various treatment options for preventing fracture in postmenopausal women with osteoporosis, an analysis of the relative safety and efficacy may aid in selecting the appropriate individualized treatment. They conducted a systematic literature review to identify all relevant randomized controlled trials involving abaloparatide treatment for postmenopausal osteoporosis and investigated its efficacy compared with placebo and other treatment options in preventing fractures.

The investigators searched 3 electronic databases (PubMed, Embase, and the Cochrane Central Register of Controlled Trials) for relevant studies published before December 20, 2017. Of 4978 screened articles, 22 studies were identified for treatment comparisons of the risk for vertebral, nonvertebral, and wrist fracture.

Treatment with abaloparatide had the greatest treatment effect vs placebo (relative risk [RR], 0.13; 95% CI, 0.04-0.34) followed by teriparatide (RR, 0.27; 95% CI, 0.20-0.37) and zoledronic acid (RR, 0.29; 95% CI, 0.23-0.36). When compared with strontium ranelate or oral bisphosphonates, treatment with abaloparatide was significantly more effective for preventing vertebral fractures. However, there was no significant difference compared with teriparatide, denosumab, raloxifene, zoledronic acid, or romosozumab when using abaloparatide as the reference treatment.

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In a similar fashion, abaloparatide had the greatest treatment effect for preventing nonvertebral fractures (RR, 0.50; 95% CI, 0.28-0.85) followed by teriparatide (RR, 0.62; 95% CI, 0.47-0.82) and romosozumab (RR, 0.64; 95% CI, 0.49-0.81). Abaloparatide also had the greatest treatment effect in wrist fracture (RR, 0.39; 95% CI, 0.15-0.90), followed by alendronate (RR, 0.46; 95% CI, 0.29-0.70) and raloxifene (RR, 0.63; 95% CI, 0.20-2.09). The benefits of abaloparatide for hip fractures were not clear.

Of the osteoporosis treatments, abaloparatide had the highest probability of preventing vertebral fractures (79%), nonvertebral fractures (70%), and wrist fractures (53%) compared with other treatment options.

The study had several limitations, including differences in the design and population characteristics of the studies included in the analysis; exclusion of non-English publications; and no consideration of adverse events, drug costs, or adherence.

“The analysis indicates that abaloparatide reduces the risk [for] fractures in women with postmenopausal osteoporosis versus placebo and compared with other treatment options,” wrote the researchers.

This study was supported by Radius Health, Inc.

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Reference

Reginster JY, Bianic F, Campbell R, Matin M, Williams SA, Fitzpatrick LA. Abaloparatide for risk reduction of nonvertebral and vertebral fractures in postmenopausal women with osteoporosis: a network meta-analysis [published online April 6, 2019]. Osteoporos Int. doi:10.1007/s00198-019-04947-2