Tags

Type your tag names separated by a space and hit enter

Efficacy of Pharmacological Therapies for the Prevention of Fractures in Postmenopausal Women: A Network Meta-Analysis.
J Clin Endocrinol Metab. 2019 05 01; 104(5):1623-1630.JC

Abstract

BACKGROUND

Osteoporosis and osteopenia are associated with increased fracture incidence in postmenopausal women. We aimed to determine the comparative effectiveness of various available pharmacological therapies.

METHODS

We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, ISI Web of Science, and Scopus for randomized controlled trials that enrolled postmenopausal women with primary osteoporosis and evaluated the risk of hip, vertebral, or nonvertebral fractures. A network meta-analysis was conducted using the multivariate random effects method.

RESULTS

We included 107 trials (193,987 postmenopausal women; mean age, 66 years; 55% white; median follow-up, 28 months). A significant reduction in hip fractures was observed with romosozumab, alendronate, zoledronate, risedronate, denosumab, estrogen with progesterone, and calcium in combination with vitamin D. A significant reduction in nonvertebral fractures was observed with abaloparatide, romosozumab, denosumab, teriparatide, alendronate, risedronate, zoledronate, lasofoxifene, tibolone, estrogen with progesterone, and vitamin D. A significant reduction in vertebral fractures was observed with abaloparatide, teriparatide, parathyroid hormone 1-84, romosozumab, strontium ranelate, denosumab, zoledronate, risedronate, alendronate, ibandronate, raloxifene, bazedoxifene, lasofoxifene, estrogen with progesterone, tibolone, and calcitonin. Teriparatide, abaloparatide, denosumab, and romosozumab were associated with the highest relative risk reductions, whereas ibandronate and selective estrogen receptor modulators had lower efficacy. The evidence for the treatment of fractures with vitamin D and calcium remains limited despite numerous large trials.

CONCLUSIONS

This network meta-analysis provides comparative effective estimates for the various available treatments to reduce the risk of fragility fractures in postmenopausal women.

Authors+Show Affiliations

Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minnesota. Unidad de Conocimiento y Evidencia (CONEVID), Universidad Peruana Cayetano Heredia, Lima, Peru.Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minnesota. Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota.Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minnesota.Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minnesota.Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minnesota.Department of Internal Medicine, School of Medicine, Wayne State University, Detroit, Michigan.Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minnesota.Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minnesota.Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minnesota.Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minnesota.Division of Pediatric Endocrinology, Sanford Children's Specialty Clinic, Sioux Falls, South Dakota.Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minnesota.Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minnesota.Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minnesota.

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

30907957

Citation

Barrionuevo, Patricia, et al. "Efficacy of Pharmacological Therapies for the Prevention of Fractures in Postmenopausal Women: a Network Meta-Analysis." The Journal of Clinical Endocrinology and Metabolism, vol. 104, no. 5, 2019, pp. 1623-1630.
Barrionuevo P, Kapoor E, Asi N, et al. Efficacy of Pharmacological Therapies for the Prevention of Fractures in Postmenopausal Women: A Network Meta-Analysis. J Clin Endocrinol Metab. 2019;104(5):1623-1630.
Barrionuevo, P., Kapoor, E., Asi, N., Alahdab, F., Mohammed, K., Benkhadra, K., Almasri, J., Farah, W., Sarigianni, M., Muthusamy, K., Al Nofal, A., Haydour, Q., Wang, Z., & Murad, M. H. (2019). Efficacy of Pharmacological Therapies for the Prevention of Fractures in Postmenopausal Women: A Network Meta-Analysis. The Journal of Clinical Endocrinology and Metabolism, 104(5), 1623-1630. https://doi.org/10.1210/jc.2019-00192
Barrionuevo P, et al. Efficacy of Pharmacological Therapies for the Prevention of Fractures in Postmenopausal Women: a Network Meta-Analysis. J Clin Endocrinol Metab. 2019 05 1;104(5):1623-1630. PubMed PMID: 30907957.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Efficacy of Pharmacological Therapies for the Prevention of Fractures in Postmenopausal Women: A Network Meta-Analysis. AU - Barrionuevo,Patricia, AU - Kapoor,Ekta, AU - Asi,Noor, AU - Alahdab,Fares, AU - Mohammed,Khaled, AU - Benkhadra,Khalid, AU - Almasri,Jehad, AU - Farah,Wigdan, AU - Sarigianni,Maria, AU - Muthusamy,Kalpana, AU - Al Nofal,Alaa, AU - Haydour,Qusay, AU - Wang,Zhen, AU - Murad,Mohammad Hassan, PY - 2019/01/25/received PY - 2019/01/25/accepted PY - 2019/3/26/pubmed PY - 2020/2/25/medline PY - 2019/3/26/entrez SP - 1623 EP - 1630 JF - The Journal of clinical endocrinology and metabolism JO - J Clin Endocrinol Metab VL - 104 IS - 5 N2 - BACKGROUND: Osteoporosis and osteopenia are associated with increased fracture incidence in postmenopausal women. We aimed to determine the comparative effectiveness of various available pharmacological therapies. METHODS: We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, ISI Web of Science, and Scopus for randomized controlled trials that enrolled postmenopausal women with primary osteoporosis and evaluated the risk of hip, vertebral, or nonvertebral fractures. A network meta-analysis was conducted using the multivariate random effects method. RESULTS: We included 107 trials (193,987 postmenopausal women; mean age, 66 years; 55% white; median follow-up, 28 months). A significant reduction in hip fractures was observed with romosozumab, alendronate, zoledronate, risedronate, denosumab, estrogen with progesterone, and calcium in combination with vitamin D. A significant reduction in nonvertebral fractures was observed with abaloparatide, romosozumab, denosumab, teriparatide, alendronate, risedronate, zoledronate, lasofoxifene, tibolone, estrogen with progesterone, and vitamin D. A significant reduction in vertebral fractures was observed with abaloparatide, teriparatide, parathyroid hormone 1-84, romosozumab, strontium ranelate, denosumab, zoledronate, risedronate, alendronate, ibandronate, raloxifene, bazedoxifene, lasofoxifene, estrogen with progesterone, tibolone, and calcitonin. Teriparatide, abaloparatide, denosumab, and romosozumab were associated with the highest relative risk reductions, whereas ibandronate and selective estrogen receptor modulators had lower efficacy. The evidence for the treatment of fractures with vitamin D and calcium remains limited despite numerous large trials. CONCLUSIONS: This network meta-analysis provides comparative effective estimates for the various available treatments to reduce the risk of fragility fractures in postmenopausal women. SN - 1945-7197 UR - https://www.unboundmedicine.com/medline/citation/30907957/Efficacy_of_Pharmacological_Therapies_for_the_Prevention_of_Fractures_in_Postmenopausal_Women:_A_Network_Meta_Analysis_ L2 - https://academic.oup.com/jcem/article-lookup/doi/10.1210/jc.2019-00192 DB - PRIME DP - Unbound Medicine ER -