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Ter7.0
Teriparatid – Forschung
Überwiegend Mechanismus / Beobachtung
28 begutachtete Studien
Was die Evidenz sagt
Überwiegend Mechanismus / Beobachtung
Die meisten Studien zu Teriparatid sind mechanistisch oder beobachtend statt RCTs, die einen klinischen Effekt messen — betrachte die Ergebnisse als vorläufig.
Die meiste Evidenz stammt aus hochwertigen Meta-Analysen und randomisierten Studien, veröffentlicht 2001–2026 mit einer typischen Studiengröße von 437 Teilnehmenden.
Basierend auf 28 Studien · 9 Meta-Analysen · 7 RCTs · 45,870 Teilnehmende insgesamt
Konfidenz
Hohe Konfidenz
Nach Outcome
Bone healthNeue Wirbelkörperfrakturen sanken von 14% unter Placebo auf ~5% (RR 0.35); nichtvertebrale Fragilitätsfrakturen etwa halbiert; Zuwächse der Knochendichte an Wirbelsäule/Femurhals übertreffen Placebo und Bisphosphonate · Über ~18-24 Monate täglicher Anwendung (Knochendichte ab ~3 Monaten messbar)
Überwiegend Mechanismus / Beobachtung21 Studien
Fracture & skeletal outcomes
Überwiegend Mechanismus / Beobachtung10 Studien
Safety profile
Überwiegend Mechanismus / Beobachtung7 Studien
Aktives Forschungsgebiet
20 Studien in den letzten 5 Jahren · Neueste Meta-Analyse: 2026
200120132026
1RCTn=1,637 · large study2001
New vertebral fractures occurred in 14 percent of the women in the placebo group and in 5 percent... of the women in the 20-microg... parathyroid hormone groups; the respective relative risks... were 0.35 and 0.31.
Neer RM, Arnaud CD, Zanchetta JR, Prince R, Gaich GA, Reginster JY, et al. · N Engl J Med (2001)
Pivotal Fracture Prevention Trial: 1637 postmenopausal women with prior vertebral fractures randomized to PTH(1-34) 20 or 40 microg/day or placebo, median 21 months
New vertebral fractures: 14% placebo vs 5% (20 microg) — relative risk 0.35 (95% CI 0.22-0.55)
New nonvertebral fragility fractures: 6% placebo vs 3% — relative risk ~0.47
2Meta-Analysen=17,872 · very large study2026
These findings support a shift toward anabolic-first treatment sequencing in this particularly vulnerable group.
Cipolloni V et al. · Medicina (Kaunas, Lithuania) (2026)
The labeled pooled summary estimate for vertebral fractures was 0.43 (95% confidence interval 0.34-0.54).
Significant risk reductions were also observed for clinical fractures (hazard ratio 0.62, 95% confidence interval 0.51-0.75), non-vertebral fractures (pooled effect estimate 0.71, 95% confidence interval 0.59-0.85), and hip fractures (risk ratio 0.65, 95% confidence interval 0.45-0.96).
Sequential therapy using an anabolic agent followed by an antiresorptive reduced spinal fracture risk by approximately half.
Romosozumab demonstrated efficacy and safety similar to teriparatide.
Bandeira TFGS et al. · International journal of rheumatic diseases (2026)
Romosozumab demonstrated efficacy and safety similar to teriparatide.
However, this overview revealed substantial overlap among primary studies, with most outcomes assessed through indirect comparisons and poor methodological quality.
Chen L, Wang Q, Gu M. · Frontiers in endocrinology (2025)
The primary outcome was the percentage change in bone mineral density(BMD)at 6 and 12 months compared to baseline.
Results Compared with placebo, alendronate, and teriparatide, anti-sclerostin antibodies significantly increased BMD at the lumbar spine, total hip, and femoral neck at 6 and 12 months.
Compared with denosumab, anti-sclerostin antibodies significantly increased lumbar spine bone mineral density at 6 months (MD = 3.68, 95% CI: 0.34-7.01, P = 0.03) and 12 months (MD = 5.20, 95% CI: 3.19-7.21, P < 0.00001).
New vertebral fractures occurred in 28 (5.4%) of 680 patients in the teriparatide group and 64 (12.0%) of 680 patients in the risedronate group (risk ratio 0.44, 95% CI 0.29-0.68; p<0.0001).
Head-to-head double-blind, double-dummy RCT of teriparatide 20 microg/day vs risedronate 35 mg/week in 1360 women with severe osteoporosis over 24 months
First osteoporosis trial powered with incident fractures as the primary outcome
New vertebral fractures: 5.4% teriparatide vs 12.0% risedronate (RR 0.44; p<0.0001)
We compared teriparatide with alendronate in 428 women and men with osteoporosis... who had received glucocorticoids for at least 3 months.
Saag KG, Shane E, Boonen S, Marín F, Donley DW, et al. · N Engl J Med (2007)
18-month randomized, double-blind, controlled head-to-head trial in 428 patients with glucocorticoid-induced osteoporosis
Teriparatide 20 microg/day vs alendronate 10 mg/day; primary outcome was change in lumbar-spine BMD
Teriparatide produced greater spine BMD gains than alendronate
7Meta-Analyse2026
Conclusion These findings provide a rigorous summary of the evidence to guide sequential medication choice for patients with osteoporosis.
Nayak S, Greenspan SL. · Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA (2026)
Meta-analysis summary estimates for BMD change on the second medication in a treatment sequence showed robust BMD gain with bisphosphonates followed by 1 year of romosozumab at the lumbar spine (10.1%, 95% CI 9.9-10.4), femoral neck (3.1%, 95% CI 2.9-3.4), and total hip (3.1%, 95% CI 2.7-3.5).
Bisphosphonates followed by 1 year of denosumab resulted in significant BMD gain at the lumbar spine (3.5%, 95% CI 2.8-4.2), femoral neck (1.5%, 95% CI 1.2-1.9), and total hip (2.1%, 95% CI 1.8-2.3).
However, bisphosphonates transitioned to 1 year of teriparatide resulted in significant BMD gain at the lumbar spine (5.1%, 95% CI 4.4-5.9) but not at the hip.
Understanding these mechanisms is important for optimizing osteoporosis therapy and developing strategies to extend teriparatide's "anabolic window."
Schmal C, Wu JY, Jafari A. · JBMR plus (2026)
In patients with severe bone loss, daily teriparatide injections increase osteoblastic activity and bone turnover, leading to net gain in bone mass, increased BMD, and significantly reduced fracture risk.
However, after 6-12 mo of treatment, its anabolic effects, reflected by increased serum bone turnover markers and LS-BMD gain, tend to diminish.
Despite various efforts to address this challenge, the underlying mechanisms have remained poorly understood.
In conclusion, a unified definition could aid multidisciplinary care teams and healthcare decision-makers in making treatment sequencing decisions.
Kendler DL et al. · Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA (2026)
In conclusion, a unified definition could aid multidisciplinary care teams and healthcare decision-makers in making treatment sequencing decisions.
Published in Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA (2026)
10Systematische Übersichtn=1,512 · large study2026
These findings support a personalized approach to conservative care and underscore the need for high-quality trials with standardized protocols and functional endpoints.
Chao WC, Chen YH, Shih JC, Cheng B, Hu MH. · Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA (2026)
Teriparatide demonstrated the greatest effect on pain reduction (SMD: - 1.75; 95% CI: - 3.10 to - 0.39) and QoL improvement (SMD: + 3.90; 95% CI: 2.33 to 5.47).
Denosumab showed moderate QoL benefit (SMD: + 3.47), while other interventions yielded smaller or non-significant effects.
Conclusion Teriparatide is the most effective non-surgical intervention for long-term pain and QoL outcomes in OVCF patients.
Bisphosphonates may remain a reasonable alternative when anabolic agents are unavailable or contraindicated.
Jin H, Jin H, Suk KS, Lee BH, Park SY, Kim HS, Moon SH, Park SR, Kim N, Shin JW, Kwon JW. · Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA (2025)
Teriparatide was associated with lower subsequent VF rates compared to the control [OR = 0.39, 95% CI = 0.16-0.97] and bisphosphonates [OR = 0.41, 95% CI = 0.30-0.56], and led to improved VAS scores at 3 months [MD (95% CI) = -1.41 (-2.47, -0.35)] compared to bisphosphonates.
Vitamin D improved RMDQ scores at 3 months [MD (95% CI) = -1.59 (-2.88, -0.31)] compared to the control.
Additionally, romosozumab was associated with lower subsequent VF rates compared to bisphosphonates in patients undergoing vertebral augmentation [OR = 0.21, 95% CI = 0.09-0.51].
Chai SJ, Yu T, Wang GR, Sun FL, Xue H, Zhang Z, Ran B. · Frontiers in endocrinology (2025)
Pairwise meta-analysis (Stata 18.0) assessed effect sizes, while NMA (R 4.3.1, gemtc and BUGSnet packages) ranked treatments for BMD changes (lumbar spine, femoral neck, total hip) and safety outcomes (adverse and serious adverse events).
Conclusions Teriparatide is the optimal choice for improving lumbar spine BMD and overall safety, while alendronate shows significant efficacy in enhancing femoral neck and hip BMD, although its safety profile is less favorable.
Thus, alendronate may be more suitable for patients needing bone density improvement at these sites.
Further studies are warranted to evaluate the potential effects of denosumab and romosozumab.
Jin H, Jin H, Suk KS, Lee BH, Park SY, Kim HS, Moon SH, Park SR, Kim N, Shin JW, Kwon JW. · The spine journal : official journal of the North American Spine Society (2025)
Results Bisphosphonate showed reduced subsequent VFs (odds ratio [OR]=0.27, 95% confidence interval [CI]=0.09-0.81) and cage subsidence (OR=0.29, 95% CI=0.11-0.75) and improved ODI scores at 12 months (standardized mean difference [SMD] [95% CI]=-0.75 [-1.42, -0.08]) compared to the control.
Teriparatide showed a higher fusion rate (OR=3.52, 95% CI=1.84-6.75), lower screw loosening (OR=0.23, 95% CI=0.09-0.60), and improved ODI scores at 24 months (SMD [95% CI]=-0.57 [-0.99, -0.15]) compared to the control.
Conclusion Our results indicated that teriparatide should be used as the first-line perioperative treatment for patients with poor bone quality scheduled for posterior spine fusion.
Both agents exhibit acceptable safety profiles, suggesting their valuable role in managing osteoporosis, particularly for high-risk patients.
Beaudart C, Veronese N, Douxfils J, Thiyagarajan JA, Bolzetta F, Albanese P, Voltan G, Alokail M, Harvey NC, Fuggle NR, Bruyère O, Rizzoli R, Reginster JY. · Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA (2025)
Abaloparatide showed an advantage over teriparatide for non-vertebral fractures (OR: 0.87, 95% CI: 0.80-0.95) and hip fractures (OR: 0.81, 95% CI: 0.71-0.93).
PTH1 analogs were better than placebo at reducing all fractures while no difference was observed for the risk of hip fracture.
Both abaloparatide and teriparatide demonstrate comparable safety to other osteoporosis treatments, with no increased cardiovascular risk.
16Systematische Übersichtn=2,046 · very large study2024
Despite an uptick in adverse events, the marked decrease in fracture incidence confirms its clinical utility for high-risk osteoporosis patients, highlighting the necessity for ongoing investigations into its full skeletal effects.
Arthur Vithran DT, Essien AE, Rahmati M, Opoku M, Keon Yon D, López Sánchez GF, Koyanagi A, Smith L, Il Shin J, Xiao W, Liu S, Li Y. · EFORT open reviews (2024)
Results Our analysis of 23 randomized controlled trials (RCTs) found that PTH (134) treatment significantly increased lumbar spine BMD (mean difference (MD) = 0.02, 95% CI: 0.01-0.03) and femoral neck BMD (MD = 0.01, 95% CI: 0.00-0.01).
Although the risk of adverse events increased (relative risk (RR) = 1.65, 95% CI: 1.32-2.07), the incidence of fractures decreased significantly (RR = 0.57, 95% CI: 0.45-0.072), with no significant difference observed in mortality rates between treatment and control groups.
Conclusion Teriparatide improves lumbar spine and femoral neck BMD in postmenopausal women.
Spine bone mineral density... by the end of therapy it was increased by 5.9% (20 microg) and 9.0% (40 microg) above baseline (p < 0.001 vs. placebo for both comparisons).
Orwoll ES, Scheele WH, Paul S, Adami S, Syversen U, Diez-Perez A, et al. · J Bone Miner Res (2003)
RCT in 437 men with osteoporosis randomized to placebo, teriparatide 20 microg, or 40 microg, plus calcium and vitamin D
Spine BMD rose 5.9% (20 microg) and 9.0% (40 microg) above baseline (p<0.001 vs placebo)
Femoral-neck BMD rose 1.5% (20 microg; p=0.029) and 2.9% (40 microg; p<0.001)
18Meta-Analysen=6,680 · very large study2024
Both teriparatide and denosumab significantly increased bone mineral density compared to bisphosphonates. Additionally, teriparatide was also shown to significantly decrease the risk of fractures.
Li M, Ge Z, Zhang B, Sun L, Wang Z, Zou T, et al. · Arch Osteoporos (2024)
Systematic review and meta-analysis of head-to-head RCTs (6680 patients) in bisphosphonate-naive osteoporosis
Teriparatide significantly increased BMD versus bisphosphonates over treatment cycles >12 months
Teriparatide significantly reduced fracture risk versus bisphosphonates
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Ramchand SK et al. · Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research (2026)
At 3 mo, teriparatide significantly increased histomorphometric indices of bone formation (BFR/BS, MS/BS, and dLS/BS) compared to denosumab or combination therapy, consistent with its greater effect on bone formation markers.
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