Tags

Type your tag names separated by a space and hit enter

Clinical efficacy and safety of drug interventions for primary and secondary prevention of osteoporotic fractures in postmenopausal women: Network meta-analysis followed by factor and cluster analysis.
PLoS One. 2020; 15(6):e0234123.Plos

Abstract

We aimed to evaluate the comparative efficacy and safety of drugs respectively for primary prevention and secondary prevention of osteoporotic fractures in postmenopausal women (PMW), and to further identify the optimal intervention(s) respectively for the two groups when efficacy and safety both considered. We searched three databases. Bayesian network meta-analyses were conducted for two efficacy outcomes (vertebral fractures and nonvertebral fractures) and two safety outcomes (tolerability and acceptability) respectively in primary prevention group and secondary prevention group. We synthesized hazard ratios (HRs) and 95% confidence intervals (CIs) for nonvertebral fractures, and risk ratios (RRs) for three others. Factor and cluster analyses on surface under the cumulative ranking curve (SUCRA) values were conducted to identify the best intervention(s) with efficacy and safety both considered. The study protocol has been registered in PROSPERO. We included 57 randomized trials involving fifteen anti-osteoporotic interventions and 106320 PMW. For primary prevention, only zoledronate (once per 18 months) reduced both vertebral (RR 0.46, 95% CI 0.28-0.74) and nonvertebral (HR 0.66, 95% CI 0.51-0.85) fractures. For secondary prevention, abaloparatide, alendronate, denosumab, lasofoxifene, risedronate, romosozumab, teriparatide, and zoledronate (once per 12 months) reduced both vertebral (RRs: from 0.17 to 0.62) and nonvertebral (HRs: from 0.54 to 0.81) fractures. PTH (1-84) and abaloparatide increased withdrawal risk. Romosozumab, teriparatide, denosumab and risedronate, with the greatest composite scores, constituted the optimal cluster having both superior efficacy and superior safety. Zoledronate used at 5 mg per 18 months, with the similar safety as placebo, is the only drug intervention which has been shown to significantly reduce both vertebral and nonvertebral fractures for primary prevention of osteoporotic fractures in PMW; while romosozumab, teriparatide, denosumab, and risedronate are the optimal treatments for secondary prevention when efficacy and safety both considered. A limitation is that safety outcomes failed to consider the severity of adverse effects.

Authors+Show Affiliations

Department of Orthopedics, The People's Hospital of Rongchang District, Chongqing, China.Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing, China.Department of Orthopedics, The People's Hospital of Rongchang District, Chongqing, China.Department of Orthopedics, Affiliated Yueyang Hospital of Hunan Normal University, Yueyang, China.Department of Orthopedics, Wu Han NO.1 Hospital, Wu Han, China.Department of Neurology, Hankou Hospital of Wuhan City, Wuhan, China.Department of General Medicine, The Central Hospital of Tuoshi Town, Tianmen, China.Department of Gynecology, The People's Hospital of Rongchang District, Chongqing, China.Department of Orthopedics, The Gaoxin District People's Hospital, Chongqing, China.

Pub Type(s)

Journal Article
Meta-Analysis

Language

eng

PubMed ID

32492050

Citation

Wen, Fei, et al. "Clinical Efficacy and Safety of Drug Interventions for Primary and Secondary Prevention of Osteoporotic Fractures in Postmenopausal Women: Network Meta-analysis Followed By Factor and Cluster Analysis." PloS One, vol. 15, no. 6, 2020, pp. e0234123.
Wen F, Du H, Ding L, et al. Clinical efficacy and safety of drug interventions for primary and secondary prevention of osteoporotic fractures in postmenopausal women: Network meta-analysis followed by factor and cluster analysis. PLoS One. 2020;15(6):e0234123.
Wen, F., Du, H., Ding, L., Hu, J., Huang, Z., Huang, H., Li, K., Mo, Y., & Kuang, A. (2020). Clinical efficacy and safety of drug interventions for primary and secondary prevention of osteoporotic fractures in postmenopausal women: Network meta-analysis followed by factor and cluster analysis. PloS One, 15(6), e0234123. https://doi.org/10.1371/journal.pone.0234123
Wen F, et al. Clinical Efficacy and Safety of Drug Interventions for Primary and Secondary Prevention of Osteoporotic Fractures in Postmenopausal Women: Network Meta-analysis Followed By Factor and Cluster Analysis. PLoS One. 2020;15(6):e0234123. PubMed PMID: 32492050.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical efficacy and safety of drug interventions for primary and secondary prevention of osteoporotic fractures in postmenopausal women: Network meta-analysis followed by factor and cluster analysis. AU - Wen,Fei, AU - Du,Hongheng, AU - Ding,Liangliang, AU - Hu,Jinxi, AU - Huang,Zifeng, AU - Huang,Hua, AU - Li,Kaikai, AU - Mo,Yuxia, AU - Kuang,Anyin, Y1 - 2020/06/03/ PY - 2019/11/26/received PY - 2020/05/19/accepted PY - 2020/6/4/entrez PY - 2020/6/4/pubmed PY - 2020/8/22/medline SP - e0234123 EP - e0234123 JF - PloS one JO - PLoS One VL - 15 IS - 6 N2 - We aimed to evaluate the comparative efficacy and safety of drugs respectively for primary prevention and secondary prevention of osteoporotic fractures in postmenopausal women (PMW), and to further identify the optimal intervention(s) respectively for the two groups when efficacy and safety both considered. We searched three databases. Bayesian network meta-analyses were conducted for two efficacy outcomes (vertebral fractures and nonvertebral fractures) and two safety outcomes (tolerability and acceptability) respectively in primary prevention group and secondary prevention group. We synthesized hazard ratios (HRs) and 95% confidence intervals (CIs) for nonvertebral fractures, and risk ratios (RRs) for three others. Factor and cluster analyses on surface under the cumulative ranking curve (SUCRA) values were conducted to identify the best intervention(s) with efficacy and safety both considered. The study protocol has been registered in PROSPERO. We included 57 randomized trials involving fifteen anti-osteoporotic interventions and 106320 PMW. For primary prevention, only zoledronate (once per 18 months) reduced both vertebral (RR 0.46, 95% CI 0.28-0.74) and nonvertebral (HR 0.66, 95% CI 0.51-0.85) fractures. For secondary prevention, abaloparatide, alendronate, denosumab, lasofoxifene, risedronate, romosozumab, teriparatide, and zoledronate (once per 12 months) reduced both vertebral (RRs: from 0.17 to 0.62) and nonvertebral (HRs: from 0.54 to 0.81) fractures. PTH (1-84) and abaloparatide increased withdrawal risk. Romosozumab, teriparatide, denosumab and risedronate, with the greatest composite scores, constituted the optimal cluster having both superior efficacy and superior safety. Zoledronate used at 5 mg per 18 months, with the similar safety as placebo, is the only drug intervention which has been shown to significantly reduce both vertebral and nonvertebral fractures for primary prevention of osteoporotic fractures in PMW; while romosozumab, teriparatide, denosumab, and risedronate are the optimal treatments for secondary prevention when efficacy and safety both considered. A limitation is that safety outcomes failed to consider the severity of adverse effects. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/32492050/Clinical_efficacy_and_safety_of_drug_interventions_for_primary_and_secondary_prevention_of_osteoporotic_fractures_in_postmenopausal_women:_Network_meta_analysis_followed_by_factor_and_cluster_analysis_ L2 - https://dx.plos.org/10.1371/journal.pone.0234123 DB - PRIME DP - Unbound Medicine ER -