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Clinical review. Comparative effectiveness of drug treatments to prevent fragility fractures: a systematic review and network meta-analysis.
J Clin Endocrinol Metab. 2012 Jun; 97(6):1871-80.JC

Abstract

CONTEXT

Osteoporosis and osteopenia are associated with increased fracture incidence.

OBJECTIVE

The aim of this study was to determine the comparative effectiveness of different pharmacological agents in reducing the risk of fragility fractures.

DATA SOURCES

We searched multiple databases through 12/9/2011.

STUDY SELECTION

Eligible studies were randomized controlled trials enrolling individuals at risk of developing fragility fractures and evaluating the efficacy of bisphosphonates, teriparatide, selective estrogen receptor modulators, denosumab, or calcium and vitamin D.

DATA EXTRACTION

Reviewers working independently and in duplicate determined study eligibility and collected descriptive, methodological quality, and outcome data.

DATA SYNTHESIS

This network meta-analysis included 116 trials (139,647 patients; median age, 64 yr; 86% females and 88% Caucasians; median follow-up, 24 months). Trials were at low to moderate risk of bias. Teriparatide had the highest risk reduction of fractures (odds ratios, 0.42, 0.30, and 0.50 for hip, vertebral, and nonvertebral fractures, respectively) and the highest probability of being ranked first for efficacy (probabilities of 42, 49, and 79% for hip, vertebral, and nonvertebral fractures, respectively). However, differences to denosumab, zoledronate, risedronate, ibandronate, and alendronate were not statistically significant. Raloxifene and bazedoxifene were likely less effective, although these data were limited. Calcium and vitamin D were ineffective given separately but reduced the risk of hip fractures if given in combination (odds ratio, 0.81; 95% confidence interval, 0.68–0.96).

CONCLUSIONS

Teriparatide, bisphosphonates, and denosumab are most effective in reducing the risk of fragility fractures. Differences in efficacy across drugs are small; therefore, patients and clinicians need to consider their associated harms and costs.

Authors+Show Affiliations

College of Medicine, Mayo Clinic, The Knowledge and Evaluation Research Unit, Division of Endocrinology, Rochester, Minnesota 55905, USA. Murad.mohammad@mayo.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Review
Systematic Review

Language

eng

PubMed ID

22466336

Citation

Murad, Mohammad Hassan, et al. "Clinical Review. Comparative Effectiveness of Drug Treatments to Prevent Fragility Fractures: a Systematic Review and Network Meta-analysis." The Journal of Clinical Endocrinology and Metabolism, vol. 97, no. 6, 2012, pp. 1871-80.
Murad MH, Drake MT, Mullan RJ, et al. Clinical review. Comparative effectiveness of drug treatments to prevent fragility fractures: a systematic review and network meta-analysis. J Clin Endocrinol Metab. 2012;97(6):1871-80.
Murad, M. H., Drake, M. T., Mullan, R. J., Mauck, K. F., Stuart, L. M., Lane, M. A., Abu Elnour, N. O., Erwin, P. J., Hazem, A., Puhan, M. A., Li, T., & Montori, V. M. (2012). Clinical review. Comparative effectiveness of drug treatments to prevent fragility fractures: a systematic review and network meta-analysis. The Journal of Clinical Endocrinology and Metabolism, 97(6), 1871-80. https://doi.org/10.1210/jc.2011-3060
Murad MH, et al. Clinical Review. Comparative Effectiveness of Drug Treatments to Prevent Fragility Fractures: a Systematic Review and Network Meta-analysis. J Clin Endocrinol Metab. 2012;97(6):1871-80. PubMed PMID: 22466336.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical review. Comparative effectiveness of drug treatments to prevent fragility fractures: a systematic review and network meta-analysis. AU - Murad,Mohammad Hassan, AU - Drake,Matthew T, AU - Mullan,Rebecca J, AU - Mauck,Karen F, AU - Stuart,Louise M, AU - Lane,Melanie A, AU - Abu Elnour,Nisrin O, AU - Erwin,Patricia J, AU - Hazem,Ahmad, AU - Puhan,Milo A, AU - Li,Tianjing, AU - Montori,Victor M, PY - 2012/4/3/entrez PY - 2012/4/3/pubmed PY - 2012/8/16/medline SP - 1871 EP - 80 JF - The Journal of clinical endocrinology and metabolism JO - J Clin Endocrinol Metab VL - 97 IS - 6 N2 - CONTEXT: Osteoporosis and osteopenia are associated with increased fracture incidence. OBJECTIVE: The aim of this study was to determine the comparative effectiveness of different pharmacological agents in reducing the risk of fragility fractures. DATA SOURCES: We searched multiple databases through 12/9/2011. STUDY SELECTION: Eligible studies were randomized controlled trials enrolling individuals at risk of developing fragility fractures and evaluating the efficacy of bisphosphonates, teriparatide, selective estrogen receptor modulators, denosumab, or calcium and vitamin D. DATA EXTRACTION: Reviewers working independently and in duplicate determined study eligibility and collected descriptive, methodological quality, and outcome data. DATA SYNTHESIS: This network meta-analysis included 116 trials (139,647 patients; median age, 64 yr; 86% females and 88% Caucasians; median follow-up, 24 months). Trials were at low to moderate risk of bias. Teriparatide had the highest risk reduction of fractures (odds ratios, 0.42, 0.30, and 0.50 for hip, vertebral, and nonvertebral fractures, respectively) and the highest probability of being ranked first for efficacy (probabilities of 42, 49, and 79% for hip, vertebral, and nonvertebral fractures, respectively). However, differences to denosumab, zoledronate, risedronate, ibandronate, and alendronate were not statistically significant. Raloxifene and bazedoxifene were likely less effective, although these data were limited. Calcium and vitamin D were ineffective given separately but reduced the risk of hip fractures if given in combination (odds ratio, 0.81; 95% confidence interval, 0.68–0.96). CONCLUSIONS: Teriparatide, bisphosphonates, and denosumab are most effective in reducing the risk of fragility fractures. Differences in efficacy across drugs are small; therefore, patients and clinicians need to consider their associated harms and costs. SN - 1945-7197 UR - https://www.unboundmedicine.com/medline/citation/22466336/Clinical_review__Comparative_effectiveness_of_drug_treatments_to_prevent_fragility_fractures:_a_systematic_review_and_network_meta_analysis_ L2 - https://academic.oup.com/jcem/article-lookup/doi/10.1210/jc.2011-3060 DB - PRIME DP - Unbound Medicine ER -