双膦酸盐和特立帕肽治疗绝经后骨质疏松症的比较：系统综述
A Comparison Between Bisphosphonates and Teriparatide in the Treatment of Postmenopausal Osteoporosis: A Systematic Review.
摘要(中文译文)
大多数临床研究仍集中于评估特立帕肽和双膦酸盐治疗骨质疏松症的疗效。本系统综述汇集了广泛研究的数据，评估了多种药物的疗效、安全性和临床结局。目的是确定特立帕肽和双膦酸盐治疗绝经后骨质疏松症的有效性和临床意义。我们分析了15项综合研究，包括随机对照试验（RCT）、系统综述和荟萃分析。主要研究包括大型试验和若干中型试验，这些试验考察了骨密度（BMD）变化、骨折风险及不良结局。在严重骨质疏松症患者中，与利塞膦酸相比，特立帕肽显著降低了椎体骨折风险，并使腰椎骨密度增加至与阿仑膦酸相当的程度，尽管其通过不同的合成代谢机制实现。与唑来膦酸联合治疗可使骨密度增益大于任一单药治疗。大多数不良事件为轻度且短暂，包括注射部位反应、恶心和头晕，与双膦酸盐相比，严重不良事件发生率无显著差异。网络荟萃分析表明，罗莫索单抗可能比特立帕肽实现更大的早期脊柱骨密度增益。特立帕肽可有效降低绝经后骨质疏松症的椎体骨折风险并提高骨密度。包括特立帕肽在内的合成代谢药物被推荐作为骨折风险极高患者（例如骨密度极低且存在现患骨折，或糖皮质激素治疗期间发生骨折）的一线治疗，随后过渡至抗骨吸收治疗。治疗选择应以基于指南的风险分层为指导，而非采用统一的阶梯式方案。
Abstract
The majority of clinical research continues to focus on evaluating the efficacy of teriparatide and bisphosphonates in the treatment of osteoporosis. This systematic review gathered data from extensive research assessing the efficacy, safety, and clinical outcomes of various medications. The objective was to determine the effectiveness and clinical implications of teriparatide and bisphosphonates in the treatment of postmenopausal osteoporosis. We analyzed 15 comprehensive studies, encompassing randomized controlled trials (RCTs), systematic reviews, and meta-analyses. The primary studies included large trials and several medium-sized trials that examined changes in bone mineral density (BMD), fracture risk, and adverse outcomes. Teriparatide significantly lowered vertebral fracture risk compared with risedronate in patients with severe osteoporosis and increased lumbar spine BMD to a comparable extent as alendronate, though via a distinct anabolic mechanism. Combination therapy with zoledronic acid resulted in greater BMD gains than either agent alone. Most adverse events were mild and transient, including injection-site reactions, nausea, and dizziness, with no significant difference in serious adverse event rates compared with bisphosphonates. Network meta-analyses indicate that romosozumab may achieve greater early spine BMD gains than teriparatide. Teriparatide is effective in lowering vertebral fracture risk and enhancing BMD in postmenopausal osteoporosis. Anabolic agents, including teriparatide, are recommended as first-line therapy for patients at very high risk of fractures (e.g., very low BMD with prevalent fractures or fractures occurring during glucocorticoid therapy), followed by a transition to antiresorptive therapy. Treatment selection should be guided by guideline-based risk stratification rather than applying a uniform stepwise approach.
如何引用
AMA
Russaal S Mann, Isha Chopra, Abdullah Kilic, Ayushi Saxena, Bilal Khan, Rupanshu Rupanshu, et al. A Comparison Between Bisphosphonates and Teriparatide in the Treatment of Postmenopausal Osteoporosis: A Systematic Review.. Cureus. 2026; doi:10.7759/cureus.106378.
APA
Russaal S Mann, Isha Chopra, Abdullah Kilic, Ayushi Saxena, Bilal Khan, Rupanshu Rupanshu, et al (2026). A Comparison Between Bisphosphonates and Teriparatide in the Treatment of Postmenopausal Osteoporosis: A Systematic Review.. Cureus. https://doi.org/10.7759/cureus.106378
GB/T 7714
Russaal S Mann, Isha Chopra, Abdullah Kilic, Ayushi Saxena, Bilal Khan, Rupanshu Rupanshu, et al. A Comparison Between Bisphosphonates and Teriparatide in the Treatment of Postmenopausal Osteoporosis: A Systematic Review.[J]. Cureus, 2026 doi:10.7759/cureus.106378.
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