For preventing glucocorticoid-induced osteoporosis, Teriparatide and Denosumab show similar or even superior benefits to Bisphosphonates.

A systematic review and meta-analysis was done to examine the safety and effectiveness of Denosumab and Teriparatide in relation to oral Bisphosphonates for averting glucocorticoid-induced osteoporosis.

A thorough search was performed across Cochrane Library, Embase, Web of Science, and PubMed databases to include relevant studies that entailed randomized controlled trials that contrasted Teriparatide or Denosumab with Bisphosphonates. Risk assessments were then pooled utilizing fixed and random effects models.

In total, the meta-analysis encompassed 10 studies incorporating 2923 subjects treated with glucocorticoids. Overall, 4 sensitivity analyses and 2 drug base evaluations were involved. Teriparatide and Denosumab outperformed Bisphosphonates in enhancing lumbar vertebrae bone mineral density (BMD), as depicted in Table 1:

Additionally, Teriparatide exhibited superiority over Bisphosphonates in preventing vertebral fractures and elevating hip BMD (mean difference [MD] 2.39%). No notable statistical distinction was observed concerning nonvertebral fracture prevention drugs, adverse events, and severe adverse events. 

With their comparable or even superior attributes to Bisphosphonates, Teriparatide and Denosumab were promising as primary treatments for osteoporosis. These treatments hold promise as primary options for managing glucocorticoid-induced osteoporosis, particularly in cases where patients have previously encountered limited effectiveness with other anti-osteoporotic medications.