Efficacy of Pharmacological Therapies for the Prevention of Fractures in Postmenopausal Women: A Network Meta-Analysis
Author:
Barrionuevo Patricia12, Kapoor Ekta13, Asi Noor1, Alahdab Fares1, Mohammed Khaled1, Benkhadra Khalid4, Almasri Jehad1, Farah Wigdan1, Sarigianni Maria1, Muthusamy Kalpana1, Al Nofal Alaa5, Haydour Qusay1, Wang Zhen1, Murad Mohammad Hassan1ORCID
Affiliation:
1. Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minnesota 2. Unidad de Conocimiento y Evidencia (CONEVID), Universidad Peruana Cayetano Heredia, Lima, Peru 3. Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota 4. Department of Internal Medicine, School of Medicine, Wayne State University, Detroit, Michigan 5. Division of Pediatric Endocrinology, Sanford Children’s Specialty Clinic, Sioux Falls, South Dakota
Abstract
Abstract
Background
Osteoporosis and osteopenia are associated with increased fracture incidence in postmenopausal women. We aimed to determine the comparative effectiveness of various available pharmacological therapies.
Methods
We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, ISI Web of Science, and Scopus for randomized controlled trials that enrolled postmenopausal women with primary osteoporosis and evaluated the risk of hip, vertebral, or nonvertebral fractures. A network meta-analysis was conducted using the multivariate random effects method.
Results
We included 107 trials (193,987 postmenopausal women; mean age, 66 years; 55% white; median follow-up, 28 months). A significant reduction in hip fractures was observed with romosozumab, alendronate, zoledronate, risedronate, denosumab, estrogen with progesterone, and calcium in combination with vitamin D. A significant reduction in nonvertebral fractures was observed with abaloparatide, romosozumab, denosumab, teriparatide, alendronate, risedronate, zoledronate, lasofoxifene, tibolone, estrogen with progesterone, and vitamin D. A significant reduction in vertebral fractures was observed with abaloparatide, teriparatide, parathyroid hormone 1-84, romosozumab, strontium ranelate, denosumab, zoledronate, risedronate, alendronate, ibandronate, raloxifene, bazedoxifene, lasofoxifene, estrogen with progesterone, tibolone, and calcitonin. Teriparatide, abaloparatide, denosumab, and romosozumab were associated with the highest relative risk reductions, whereas ibandronate and selective estrogen receptor modulators had lower efficacy. The evidence for the treatment of fractures with vitamin D and calcium remains limited despite numerous large trials.
Conclusions
This network meta-analysis provides comparative effective estimates for the various available treatments to reduce the risk of fragility fractures in postmenopausal women.
Publisher
The Endocrine Society
Subject
Biochemistry, medical,Clinical Biochemistry,Endocrinology,Biochemistry,Endocrinology, Diabetes and Metabolism
Reference16 articles.
1. Consensus development conference: diagnosis, prophylaxis, and treatment of osteoporosis;Consensus development conference;Am J Med,1993 2. Updated data on proximal femur bone mineral levels of US adults;Looker;Osteoporos Int,1998 3. BMD at multiple sites and risk of fracture of multiple types: long-term results from the Study of Osteoporotic Fractures;Stone;J Bone Miner Res,2003 4. Clinical review. Comparative effectiveness of drug treatments to prevent fragility fractures: a systematic review and network meta-analysis;Murad;J Clin Endocrinol Metab,2012 5. Moreno PB, Kapoor E, Asi N, Alahdab F, Mohammed K, Benkhadra K, Almasri J, Farah W, Sarigianni M, Muthusamy K, Al Nofal A, Haydour Q, Wang Z, Murad MH. Data from: Efficacy of pharmacological therapies for the prevention of fractures in postmenopausal women: a network meta-analysis. Figshare. Deposited 25 January 2019. https://doi.org/10.6084/m9.figshare.7629344.
Cited by
199 articles.
订阅此论文施引文献
订阅此论文施引文献，注册后可以免费订阅5篇论文的施引文献，订阅后可以查看论文全部施引文献
|
|