Abstract
Although a range of pharmacological interventions is available, it remains uncertain which treatment for osteoporosis is more effective. This network meta-analysis study aimed to compare different drug efficacy and safety in randomized controlled trials (RCTs) for the treatment of postmenopausal osteoporosis. PubMed, EMBASE, MEDLINE, Clinicaltrial.gov, Cochrane library, Google scholar were searched up to 31 October 2020. Randomized placebo-controlled trials that reported measures of bone mineral density (BMD) percentage change and/or numbers of adverse events of postmenopausal osteoporosis patients were included. Network meta-analysis was conducted using frequentist approach. Ninety-four RCTs comprising 15,776 postmenopausal osteoporosis females were included in the network meta-analysis. Compared with placebo, most interventions showed increase in BMD change. According to surfaces under the cumulative ranking curves (SUCRAs), strontium ranelate, fluoride, and hormone replacement therapy were most effective in increasing total hip, lumbar spine, and distal radius BMD, respectively. Parathyroid hormone (PTH) was most effective in preventing new hip fracture. When taking into account all anatomic sites, bisphosphonate (BP), monoclonal antibody (mAb), and fluoride have a balanced efficacy in increasing BMD at all sites. Considering both the effectiveness of increasing BMD and preventing hip fracture, mAb, BP, and PTH are more favorable among all interventions. The treatment effects of different medications on BMD percentage change are anatomic site-dependent. After weighing anti-osteoporosis treatment efficacy against risk of complications, BP and mAb are the more favorable interventions to increase BMD at all sites and reduce the risks of hip fracture and death.
Highlights
Osteoporosis is a common metabolic bone disease and major worldwide public health problem that leads to an increase in bone fragility and susceptibility to fracture [1]
strontium ranelate (SrRan) (5.65; 3.83–7.46) was most effective in increasing bone mineral density (BMD) at total hip (TH) followed by monoclonal antibody (mAb), hormone replacement (HRT), BP, and Parathyroid hormone (PTH)
When taking into account all anatomic sites for the effectiveness of osteoporosis treatment, BP, mAb, and fluoride seem to have a balanced efficacy in increasing BMD at all sites (Figure 6A)
Summary
Osteoporosis is a common metabolic bone disease and major worldwide public health problem that leads to an increase in bone fragility and susceptibility to fracture [1]. The osteoporosis-related fractures are complicated with significant morbidity and mortality [2,3,4]. Because the decrease in estrogen production accelerates bone loss, osteoporosis is quite common in postmenopausal women [8,9,10]. Hip fractures are the greatest complication since they may influence the baseline functionality (Barthel index) of osteoporosis patients [11]. Patients with osteoporosisrelated fractures are at a higher risk of subsequent re-fractures and are associated with increased morbidity and premature mortality [12]. The anti-osteoporosis medication taken for a year or more reduces the incidence of re-fractures by 70% [13].
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