Bisphosphonates for Secondary Prevention of Osteoporotic Fractures: A Bayesian Network Meta-Analysis of Randomized Controlled Trials.

Lei Shi,Qing-Yun Xue,Nan Min,Fei Wang

doi:10.1155/2019/2594149

Abstract

Purpose To investigate the comparative efficacies of the five most commonly used bisphosphonates for the secondary prevention of osteoporotic fractures in a Bayesian network meta-analysis. Methods Five databases and the reference lists of all acquired articles from inception to July 2017 were searched. A Bayesian random-effects model was employed, and vertebral, hip and nonvertebral nonhip fractures were assessed by odds ratios (ORs) and 95%credible intervals. Furthermore, with respect to each endpoint, rank probabilities for each bisphosphonate were evaluated using the surface under the cumulative ranking curve (SUCRA) value. Results Thirteen eligible studies were identified involving 11,822 patients with osteoporotic fractures. Overall in the pairwise meta-analyses, bisphosphonate use significantly reduced the risk of new vertebral, hip, and nonvertebral nonhip fractures, with ORs and 95% confidence intervals of 0.56 (0.49–0.64), 0.69 (0.48–0.98), and 0.82 (0.70–0.97), respectively. In network meta-analyses, significant differences were found between placebo and any one of the five bisphosphonates for new vertebral fractures. The rank probability plot and the SUCRA calculation results suggested that alendronate was the best intervention (14.6%) for secondary prevention of vertebral fractures, followed by zoledronate (15.3%) and etidronate (22.1%). In terms of the incidence of new hip fractures, alendronate was associated with the lowest incidence (18.5%), followed by zoledronate (43.1%) and risedronate (52.5%). However, zoledronate ranked lowest (16.6%) regarding the incidence of new nonvertebral nonhip fractures, followed by risedronate (23.8%) and alendronate (44.1%). Conclusions Bisphosphonates show significant efficacy for secondary prevention of new vertebral fractures, and alendronate is most likely to be successful at secondary prevention of vertebral and hip fractures compared with the other four bisphosphonates.

Highlights

Osteoporosis, which primarily a ects postmenopausal women and the elderly population, is characterized by low bone mineral density and decreased bone strength and is the leading cause of fragility fractures, namely, osteoporotic fractures, including vertebral, hip, and nonhip nonvertebral fractures [1, 2]
Osteoporotic fractures result in health and life quality deterioration, which in turn creates a heavy burden for patients and health system
Relevant studies published from database inception to July, 2017 were retrieved from the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed MEDLINE, Embase, Chinese National Knowledge Infrastructure (CNKI), and Chinese Wanfang Data Knowledge Service Platform. e keywords used in the searches were: osteoporotic fractures, bisphosphonates, and secondary prevention

Summary

Introduction

Osteoporosis, which primarily a ects postmenopausal women and the elderly population, is characterized by low bone mineral density and decreased bone strength and is the leading cause of fragility fractures, namely, osteoporotic fractures, including vertebral, hip, and nonhip nonvertebral fractures [1, 2]. Beyond the age of approximately 50 years, 22% of men, and 50% of women will experience an osteoporotic fracture. As a consequence, these patients are at an increased risk of several adverse outcomes, such as subsequent fracture, morbidity, and mortality [3, 4]. Prevention of osteoporotic fractures is the main therapeutic target in osteoporosis treatment, and medication is a crucial approach, with bisphosphonates being the most commonly prescribed modality [5]. In the United Kingdom, about 10% of females aged 70 years or older with osteoporosis are prescribed bisphosphonates, making it one of the most frequently prescribed drug class in this patient population [6,7,8]

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