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Comparative efficacy of bone anabolic therapies in women with postmenopausal osteoporosis: A systematic review and network meta-analysis of randomized controlled trials.
Maturitas. 2019 Nov; 129:12-22.M

Abstract

OBJECTIVE

To systematically evaluate the effects of bone anabolic therapies (BATs) - specifically, drug therapy with teriparatide, abaloparatide or romosozumab - on fractures, bone mineral density (BMD), and bone metabolites in postmenopausal osteoporosis.

METHODS

Six computerized engines were searched through to November 2018. We selected randomized controlled trials (RCTs) evaluating the effect of BATs on postmenopausal osteoporosis and with at least 6 months of follow-up. Controls were placebo, no treatment, or bisphosphonates. Primary outcomes were vertebral and non-vertebral fractures. Secondary outcomes were: BMD determined by dual energy X-ray absorptiometry at total hip, lumbar spine, and femoral neck; N-terminal propeptide of type I procollagen (PINP); C-terminal telopeptide of type I collagen (CTX); and severe adverse events (SAE). We followed the PRISMA guidelines for reporting, and used version 2 of the Cochrane risk-of-bias tool. Frequentist network meta-analyses were performed per outcome. Effects for dichotomous and continuous outcomes were expressed as relative risks and mean differences and their 95% confidence intervals. We used p-scores to rank best treatments per outcome.

RESULTS

Sixteen RCTs (n = 18,940) were evaluated. Mean ages ranged between 61 and 74 years, and follow-up times between 6 and 30 months. Four RCTs (n = 971) excluded patients with previous fractures. In contrast to placebo/no treatment, all BATs significantly reduced the risk of vertebral fractures, but no intervention significantly reduced the risk of non-vertebral fractures; abaloparatide ranked better than other interventions for both fracture types (p-scores: 0.95, and 0.89, respectively). All BATs significantly increased BMD at all locations in comparison with placebo/no treatment; romosozumab consistently ranked better than other interventions at all BMD locations (p-scores >0.86). Teriparatide ranked better than other interventions for increasing PINP. No differences in SAE were observed among treatments.

CONCLUSIONS

Abaloparatide, romosozumab, and teriparatide are the best treatments, respectively, to reduce vertebral/non-vertebral fractures, increase BMD, and increase bone formation.

Authors+Show Affiliations

University of Connecticut, Hartford Hospital Evidence-based Practice Center, Hartford, CT 06102, United States; School of Medicine, Universidad Peruana de Ciencias Aplicadas (UPC), Lima 9, Peru.University of Zaragoza Faculty of Medicine and Aragón Health Research Institute, Zaragoza 50009, Spain. Electronic address: faustino.perez@unizar.es.Universidad San Ignacio de Loyola (USIL), Lima, Peru.ProEd Communications, Inc., Cleveland, OH, United States.University of Connecticut, Hartford Hospital Evidence-based Practice Center, Hartford, CT 06102, United States.Hemex Health Inc., Portland, OR, United States.University of Zaragoza Faculty of Medicine and Aragón Health Research Institute, Zaragoza 50009, Spain.

Pub Type(s)

Journal Article
Meta-Analysis
Systematic Review

Language

eng

PubMed ID

31547908

Citation

Hernandez, Adrian V., et al. "Comparative Efficacy of Bone Anabolic Therapies in Women With Postmenopausal Osteoporosis: a Systematic Review and Network Meta-analysis of Randomized Controlled Trials." Maturitas, vol. 129, 2019, pp. 12-22.
Hernandez AV, Pérez-López FR, Piscoya A, et al. Comparative efficacy of bone anabolic therapies in women with postmenopausal osteoporosis: A systematic review and network meta-analysis of randomized controlled trials. Maturitas. 2019;129:12-22.
Hernandez, A. V., Pérez-López, F. R., Piscoya, A., Pasupuleti, V., Roman, Y. M., Thota, P., & Herrera, A. (2019). Comparative efficacy of bone anabolic therapies in women with postmenopausal osteoporosis: A systematic review and network meta-analysis of randomized controlled trials. Maturitas, 129, 12-22. https://doi.org/10.1016/j.maturitas.2019.08.003
Hernandez AV, et al. Comparative Efficacy of Bone Anabolic Therapies in Women With Postmenopausal Osteoporosis: a Systematic Review and Network Meta-analysis of Randomized Controlled Trials. Maturitas. 2019;129:12-22. PubMed PMID: 31547908.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparative efficacy of bone anabolic therapies in women with postmenopausal osteoporosis: A systematic review and network meta-analysis of randomized controlled trials. AU - Hernandez,Adrian V, AU - Pérez-López,Faustino R, AU - Piscoya,Alejandro, AU - Pasupuleti,Vinay, AU - Roman,Yuani M, AU - Thota,Priyaleela, AU - Herrera,Antonio, Y1 - 2019/08/10/ PY - 2019/06/05/received PY - 2019/08/05/revised PY - 2019/08/06/accepted PY - 2019/9/25/entrez PY - 2019/9/25/pubmed PY - 2019/12/21/medline KW - Abaloparatide KW - Anabolic therapy KW - Bone KW - Fractures KW - Postmenopausal osteoporosis KW - Romosozumab KW - Teriparatide SP - 12 EP - 22 JF - Maturitas JO - Maturitas VL - 129 N2 - OBJECTIVE: To systematically evaluate the effects of bone anabolic therapies (BATs) - specifically, drug therapy with teriparatide, abaloparatide or romosozumab - on fractures, bone mineral density (BMD), and bone metabolites in postmenopausal osteoporosis. METHODS: Six computerized engines were searched through to November 2018. We selected randomized controlled trials (RCTs) evaluating the effect of BATs on postmenopausal osteoporosis and with at least 6 months of follow-up. Controls were placebo, no treatment, or bisphosphonates. Primary outcomes were vertebral and non-vertebral fractures. Secondary outcomes were: BMD determined by dual energy X-ray absorptiometry at total hip, lumbar spine, and femoral neck; N-terminal propeptide of type I procollagen (PINP); C-terminal telopeptide of type I collagen (CTX); and severe adverse events (SAE). We followed the PRISMA guidelines for reporting, and used version 2 of the Cochrane risk-of-bias tool. Frequentist network meta-analyses were performed per outcome. Effects for dichotomous and continuous outcomes were expressed as relative risks and mean differences and their 95% confidence intervals. We used p-scores to rank best treatments per outcome. RESULTS: Sixteen RCTs (n = 18,940) were evaluated. Mean ages ranged between 61 and 74 years, and follow-up times between 6 and 30 months. Four RCTs (n = 971) excluded patients with previous fractures. In contrast to placebo/no treatment, all BATs significantly reduced the risk of vertebral fractures, but no intervention significantly reduced the risk of non-vertebral fractures; abaloparatide ranked better than other interventions for both fracture types (p-scores: 0.95, and 0.89, respectively). All BATs significantly increased BMD at all locations in comparison with placebo/no treatment; romosozumab consistently ranked better than other interventions at all BMD locations (p-scores >0.86). Teriparatide ranked better than other interventions for increasing PINP. No differences in SAE were observed among treatments. CONCLUSIONS: Abaloparatide, romosozumab, and teriparatide are the best treatments, respectively, to reduce vertebral/non-vertebral fractures, increase BMD, and increase bone formation. SN - 1873-4111 UR - https://www.unboundmedicine.com/medline/citation/31547908/Comparative_efficacy_of_bone_anabolic_therapies_in_women_with_postmenopausal_osteoporosis:_A_systematic_review_and_network_meta_analysis_of_randomized_controlled_trials_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0378-5122(19)30566-3 DB - PRIME DP - Unbound Medicine ER -