Abaloparatide 80micrograms/40microlitres solution for injection 1.5ml pre-filled disposable devices

The National Osteoporosis Guideline Group (NOGG) has updated the revised UK guideline for the assessment and management of osteoporosis and the prevention of fragility fractures in postmenopausal women, and men age 50 years and older. This guideline is relevant for all healthcare professionals involved in osteoporosis management.IntroductionThe UK National Osteoporosis Guideline Group (NOGG) first produced a guideline on the prevention and treatment of osteoporosis in 2008, with updates in 2013, 2017 and 2021. This paper presents a minor update of the 2021 guideline, the scope of which is to review the assessment and management of osteoporosis and the prevention of fragility fractures in postmenopausal women and men aged 50 years and older.MethodsWhere available, systematic reviews, meta-analyses and randomised controlled trials have been used to provide the evidence base. Conclusions and recommendations have been systematically graded according to the strength of the available evidence.ResultsReview of the evidence and recommendations are provided for the diagnosis of osteoporosis, fracture-risk assessment and intervention thresholds, management of vertebral fractures, non-pharmacological and pharmacological treatments, including duration and monitoring of anti-resorptive therapy, glucocorticoid-induced osteoporosis, as well as models of care for fracture prevention. Recommendations are made for training, service leads and commissioners of healthcare, and for review criteria for audit and quality improvement. Specific 2024 updates include guidance on fracture risk assessment by ethnicity, Parkinson's disease, Down's syndrome and lower-limb amputation; furthermore, the definition of very high fracture risk has been clarified. Hormone replacement therapy (HRT) is now recommended as a first-line treatment option in younger postmenopausal women with high fracture risk and low baseline risk for adverse events; recommendations regarding abaloparatide are included; additional training resources have been added.ConclusionThe guideline provides a comprehensive overview of the assessment and management of osteoporosis for all healthcare professionals involved in its management. This position paper has been endorsed by the International Osteoporosis Foundation and the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO).

Abstract licence: CC BY

BackgroundEvidence from randomized controlled trials (RCTs) on pharmacological management of primary osteoporosis in men is fragmented, making direct comparisons across drug classes difficult, and head-to-head evidence remains limited. We performed a network meta-analysis (NMA) to compare the relative efficacy and safety of commonly used anti-osteoporotic agents in men.MethodsWe systematically searched PubMed, Web of Science, and the Cochrane Library from inception to December 2025 for RCTs enrolling men with primary osteoporosis. Eligible interventions included oral bisphosphonates (OBP), intravenous bisphosphonates (IBP), abaloparatide (ABA), denosumab (DEN), teriparatide (TER), and odanacatib (ODN), compared with placebo/usual care (PLA/CTRL) or active treatments. Primary efficacy outcomes were changes in bone mineral density (BMD) at the lumbar spine (LS), total hip (TH), and femoral neck (FN), preferentially extracted at the time point closest to 12 months (range: 6-24 months). Safety outcomes were any adverse events (AEs) and serious adverse events (SAEs). Pairwise meta-analyses were conducted in Stata 18.0, and NMA in R 4.3.1 under a consistency framework. Treatments were ranked using SUCRA. The protocol was registered in PROSPERO (CRD420261279572).ResultsTwenty-one RCTs (n = 4,409) were included. Compared with PLA/CTRL, TER and ABA significantly improved FN-BMD (TER: MD 2.97, 95% CI 0.74-5.20; ABA: MD 2.83, 95% CI 0.11-5.55), and OBP also showed benefit (MD 1.61, 95% CI 0.15-3.07). For TH-BMD, significant gains were observed for OBP (MD 2.25, 95% CI 1.70-2.81), ABA (MD 2.13, 95% CI 1.43-2.83), and TER (MD 1.12, 95% CI 0.35-1.89); OBP showed a greater increase than TER (MD 1.13, 95% CI 0.32-1.95). For LS-BMD, ABA (MD 7.31, 95% CI 4.25-10.37), TER (MD 6.97, 95% CI 4.53-9.42), and OBP (MD 3.43, 95% CI 1.84-5.02) were superior to PLA/CTRL, and both ABA and TER outperformed OBP (ABA vs OBP: MD 3.88, 95% CI 0.44-7.33; TER vs OBP: MD 3.55, 95% CI 1.08-6.01). Most head-to-head comparisons across active agents were inconclusive with wide uncertainty. Node-splitting suggested no significant local inconsistency (P > 0.05). Safety comparisons for AEs and SAEs were largely imprecise; SUCRA rankings should therefore be interpreted cautiously.ConclusionsIn men with primary osteoporosis, treatment effects on BMD differ by skeletal site: ABA and TER yield larger gains at the lumbar spine, whereas OBP demonstrates robust improvements at the total hip; evidence for femoral neck improvement is clearer for TER and ABA versus PLA/CTRL. However, the extent to which these BMD improvements translate into fracture risk reduction remains uncertain because direct fracture endpoint data were limited in the included RCTs. Safety evidence also remains limited due to imprecision, and SUCRA rankings should therefore be interpreted alongside effect estimates and their uncertainty. Further high-quality, long-term RCTs focusing on fracture outcomes and drug-specific adverse events are warranted.

Abstract licence: CC BY

Background and Objectives: Individuals classified as having very high fracture risk remain vulnerable to imminent fractures even when treated with antiresorptive therapies. This meta-analysis evaluated whether initiating treatment with anabolic agents, including teriparatide, abaloparatide, and romosozumab, provides superior fracture protection in this high-risk population. Materials and Methods: A systematic review and meta-analysis of randomized controlled trials was conducted following PRISMA standards. Eligible studies included adults at very high fracture risk, defined by recent or multiple fragility fractures or markedly low bone mineral density, who received anabolic therapy as initial treatment compared with placebo or antiresorptive agents. Outcomes of interest were new vertebral, non-vertebral, hip, and clinical fractures. Effect estimates were pooled using random-effects models. Results: Six randomized trials encompassing 17,872 participants were analyzed. Initiation with anabolic therapy was associated with a marked reduction in incident vertebral fractures. 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). Exploratory subgroup analyses suggested greater vertebral fracture protection versus placebo and persistent benefit versus active antiresorptive comparators. Sequential therapy using an anabolic agent followed by an antiresorptive reduced spinal fracture risk by approximately half. Considerable heterogeneity was noted for vertebral fracture outcomes. Conclusions: Starting osteoporosis treatment with anabolic agents results in faster and more-pronounced fracture risk reduction across all major fracture categories in patients at very high fracture risk. These findings support a shift toward anabolic-first treatment sequencing in this particularly vulnerable group.

Abstract licence: CC BY

BackgroundOsteoporosis in men is an increasingly recognized health issue associated with reduced bone mineral density (BMD) and elevated fracture risk. While both antiresorptive and anabolic therapies are recommended in clinical practice, evidence directly comparing these drug classes in male populations remains limited.MethodsWe performed a systematic review and Bayesian network meta-analysis (NMA), registered on PROSPERO (CRD420251151177), to assess the efficacy and safety of pharmacological interventions for male osteoporosis. Randomized controlled trials (RCTs) evaluating alendronate, risedronate, zoledronic acid, denosumab, teriparatide, or abaloparatide were identified from PubMed, Web of Science, and the Cochrane Library through 2025. Primary outcomes included percent change in lumbar spine, femoral neck, and total hip BMD at 12 months. Safety outcomes were all adverse events (AEs) and serious adverse events (SAEs). Category-level meta-analyses were further conducted to compare pooled effects of antiresorptive versus anabolic agents.ResultsEighteen RCTs comprising 19-1199 participants each were included. At the drug level, abaloparatide and teriparatide ranked highest for lumbar spine BMD, while alendronate and abaloparatide demonstrated the most favorable effects for femoral neck and total hip BMD, respectively. Safety profiles were broadly similar, with teriparatide and alendronate showing relatively lower risks of AEs and SAEs. At the class level, anabolic therapies significantly outperformed antiresorptives in improving lumbar spine (MD 6.62, 95% CI 5.01-8.23 vs. 3.58, 95% CI 2.52-4.64) and total hip BMD (3.53, 95% CI 2.18-4.89 vs. 1.98, 95% CI -1.10-5.06), whereas antiresorptives showed modest advantages at the femoral neck (1.66, 95% CI 0.57-2.75 vs. 1.43, 95% CI -0.03-2.86). No significant differences were observed between classes in AEs or SAEs.ConclusionsThis study provides the first comprehensive drug- and class-level synthesis of treatments for male osteoporosis. Anabolic agents confer greater efficacy at the lumbar spine and total hip, while antiresorptives may offer modest benefits at the femoral neck. Safety outcomes were comparable across drug classes, suggesting that treatment choice should primarily be guided by efficacy considerations.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD420251151177.

Abstract licence: CC BY