From the Guidelines
Prolia (denosumab) is recommended over teriparatide for the treatment of osteoporosis due to its convenient administration schedule, effectiveness in reducing fracture risk, and more consistent bone mineral density improvements throughout the skeleton, as supported by the most recent and highest quality study 1.
Comparison of Prolia and Teriparatide
Prolia (denosumab) and teriparatide are both effective medications for osteoporosis, but they work through different mechanisms and have distinct clinical applications. Prolia is an antiresorptive agent that inhibits osteoclast formation, reducing bone breakdown, while teriparatide is an anabolic agent that stimulates new bone formation.
Clinical Applications and Recommendations
For most patients with osteoporosis, Prolia is often recommended as first-line therapy due to its convenient twice-yearly 60mg subcutaneous injection schedule and effectiveness in reducing fracture risk at multiple skeletal sites 1. Teriparatide, administered as a daily 20mcg subcutaneous injection for up to 24 months, is typically reserved for patients with severe osteoporosis, those who have failed other therapies, or patients with multiple fractures.
Efficacy and Safety
Prolia tends to produce more consistent bone mineral density improvements throughout the skeleton, while teriparatide shows particular strength in building vertebral bone. Side effect profiles differ, with Prolia potentially causing hypocalcemia and increased infection risk, while teriparatide may cause hypercalcemia, nausea, and dizziness.
Treatment Considerations
Treatment cost is another consideration, as teriparatide is generally more expensive. The choice between these medications should be individualized based on fracture risk, previous treatment response, comorbidities, and patient preference regarding administration frequency, as suggested by the American College of Physicians 1 and supported by recent evidence 1.
- Key factors to consider when choosing between Prolia and teriparatide include:
- Fracture risk
- Previous treatment response
- Comorbidities
- Patient preference regarding administration frequency
- Treatment cost
- Recent studies have demonstrated the benefits of denosumab for BMD at the lumbar spine, femoral neck, and total hip, with a meta-analysis showing an MD of 5.80% (95% CI 3.5–8.1) at the lumbar spine, an MD of 2.07% (95% CI 1.23–2.92) at the femoral neck, and an MD of 2.28% (95% CI 1.51–3.04) at the total hip 1.
From the Research
Comparison of Prolia and Teriparatide
- Prolia (denosumab) and Teriparatide are two medications used to treat osteoporosis, with different mechanisms of action 2, 3.
- Denosumab is a human monoclonal antibody that targets the key bone resorption mediator RANKL, while Teriparatide is a recombinant form of parathyroid hormone that stimulates bone formation 2, 4.
- Studies have shown that denosumab reduces the risk of vertebral, nonvertebral, and hip fractures, and increases bone mineral density (BMD) in postmenopausal women with osteoporosis 2, 3.
- Teriparatide has also been shown to increase BMD and reduce the risk of fractures, and may be more effective in improving lumbar spine and femur neck BMD than denosumab 4, 5.
- A study comparing the combination of denosumab and high-dose teriparatide found that this combination increased spine and hip BMD more than standard combination therapy 4.
- In terms of safety, denosumab has been generally well tolerated, although there is a potential increased risk of multiple vertebral fractures after discontinuation of the drug 2.
- Teriparatide has also been generally well tolerated, although it may cause more adverse events such as joint pain, muscle cramp, and fatigue than denosumab 4.
Efficacy and Safety
- Both denosumab and teriparatide have been shown to be effective in improving BMD and reducing the risk of fractures in patients with osteoporosis 2, 4, 5.
- A Bayesian network meta-analysis found that teriparatide and denosumab were more effective in improving lumbar spine and femur neck BMD, and reducing vertebrae fracture, than bisphosphonates 5.
- However, the analysis also found that alendronate and teriparatide had the lowest incidences of adverse events and serious adverse events 5.
Treatment Adherence
- Denosumab has been shown to have a positive impact on treatment adherence due to its longer dosing interval and rapid increase in BMD 6.
- The study found that the rarity of adverse events and reduced dosage frequency, combined with positive feedback to patients based on measured BMD increases, had a significant and positive impact on patient adherence to denosumab therapy 6.