| Title | Prevention of vertebral fractures in osteoporosis: mixed treatment comparison of bisphosphonate therapies. | | Author(s) | Jansen JP, Bergman GJ, Huels J, Olson M | | Institution | Mapi Values, Boston, MA 02114, USA. jeroen.jansen@mapivalues.com | | Source | Curr Med Res Opin 2009 Aug; 25(8):1861-8. | | MeSH | Aged
Aged, 80 and over
Diphosphonates
Fractures, Bone
Humans
Middle Aged
Osteoporosis
Randomized Controlled Trials as Topic
Spine
| | Abstract | OBJECTIVE: The objective was to compare the efficacy of bisphosphonates regarding the prevention of vertebral fractures in postmenopausal women with osteoporosis.
METHODS: Seven randomized placebo controlled trials investigating the effects of zoledronic acid (one study), alendronate (three studies), ibandronate (one study), and risedronate (two studies) in terms of fractures with a follow-up of 3 years were identified with a systematic literature search. The endpoint of interest was vertebral fractures. Results of all trials were analyzed simultaneously with a Bayesian mixed treatment comparison (MTC). With MTC the relative treatment effect of one intervention to another can be obtained in the absence of head-to-head evidence. MTC can be considered a valid method when included studies are comparable regarding effect modifying baseline patient and study characteristics.
RESULTS: There is a 98% probability that zoledronic acid shows the greatest reduction in vertebral fractures of all four bisphophonates compared. Zoledronic acid showed an OR of 0.28 (95% Credible Interval 0.22; 0.35) relative to placebo, an OR of 0.57 (0.36; 0.92) relative to ibandronate, an OR of 0.54 (0.39; 0.75) relative to alendronate, and an OR of 0.49 (0.34; 0.69) relative to risedronate. Alendronate, ibandronate, and risedronate showed comparable vertebral fracture reductions. Indirect comparisons using a conservative random effects model supported these findings.
CONCLUSION: An indirect comparison of findings from placebo controlled randomized studies indicates that zoledronic acid provides a greater vertebral fracture risk reduction in postmenopausal women with osteoporosis than ibandronate, alendronate, or risedronate. | | Language | eng | | Pub Type(s) | Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
| | PubMed ID | 19530978 |
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