A network meta-analysis published in the Journal of Clinical Endocrinology & Metabolism compared the effectiveness of various pharmacological agents used for the prevention of fractures in postmenopausal women with osteoporosis.

For this investigation, researchers searched for randomized controlled trials that included postmenopausal women with primary osteoporosis or osteopenia at risk of developing fractures, and where pharmacological interventions were compared to each other or placebo and reported on vertebral, hip, and nonvertebral fragility fractures. They identified 107 trials involving 193,987 women with a median follow-up of 28 months.

Results showed that compared with placebo, treatment with romosozumab, alendronate, zoledronate, risedronate, denosumab, estrogen with progesterone and calcium combined with vitamin D was associated with a significant reduction in hip fractures, while abaloparatide, romosozumab, denosumab, teriparatide, alendronate, risedronate, zoledronate, lasofoxifene, tibolone, estrogen with progesterone and vitamin D were all observed to reduce nonvertebral fractures.

As for vertebral fractures, a significant reduction in risk was seen with abaloparatide, teriparatide, PTH 1-84, romosozumab, strontium ranelate, denosumab, zoledronate, risedronate, alendronate, ibandronate, raloxifene, bazedoxifene, lasofoxifene, estrogen with progesterone, tibolone and calcitonin, compared with placebo.

Overall, treatments that were associated with the greatest relative risk reduction in fragility fractures included teriparatide, abaloparatide, denosumab, romosozumab and most bisphosphonates (ibandronate had lower efficacy vs other bisphosphonates). With regard to vitamin D and calcium, despite many randomized trials, evidence for efficacy in fracture reduction remains limited, the authors stated.

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“It is important to note that the superiority of a certain drug in relative terms does not necessarily mean that the absolute difference from another drug is substantial,” the study authors explained. “In addition, this analysis focused on fracture prevention; however, decision-making also incorporates other concepts such as the cost of a drug, convenience of administration, related side effects and tolerability.”

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