Alendronate versus Raloxifene for Postmenopausal Women: A Meta-Analysis of Seven Head-to-Head Randomized Controlled Trials

Abstract

Purpose. The aim of this study was to directly compare the efficacy and the safety of the two agents for postmenopausal women. Methods/Principal Findings. Electronic databases were searched for relevant articles that met our predefined inclusion criteria. Seven randomized controlled trials (RCTs) involving 4054 women were identified and included. Although Aln was more effective than Rlx in increasing bone mineral density (BMD), no statistical differences were observed in reducing the risk of neither vertebral fractures (P = 0.45) nor nonvertebral fractures (P = 0.87) up to two-year followup. Aln reduced the risk of vasomotor (P = 0.006) but increased the risk of diarrhea compared to Rlx (P = 0.01). Our subgroup analysis further indicated the difference between Aln and Rlx in fracture risk and was not materially altered by the administration pattern, the age. The weekly strategy of Aln would further reduce the upper gastrointestinal (GI) disorders and might gain more bone mass increment at lumbar spine compared to its daily treatment. Conclusion. There was no evidence of difference of fracture risk reduction between Aln and Rlx. In addition, age did not obviously influence their relative antifracture efficacy. For Aln the weekly strategy would further reduce the upper GI disorders and gain more bone mass increment compared to the daily treatment. During clinical decision making, the patients' adherence and the related side-effects associated with both drugs should also be taken into account.

Comparison of Osteoporosis Pharmacotherapy Fracture Rates: Analysis of a MarketScan® Claims Database Cohort

“…No statistically significant results were found based on route of administration of bisphosphonates, nor between raloxifene and alendronate. Previous randomized trials and retrospective studies have found no difference between alendronate and raloxifene, and other reviews and analyses have concluded that minimal differences in efficacy exist between different medication options ( 4 , 14 - 16 ). The fact that our study did not find statistically significant differences supports the results from these studies.…”

Comparison of Calipers for Matching on the Disease Risk Score

“…While unmeasured confounding and differences in study populations and adherence preclude direct comparisons of associations with those from prior observational and randomized studies, these prior estimates can provide a rough guide about the direction and magnitude of the expected results. Thus, we expected the topperforming calipers to produce results close to the null in the raloxifene example, results slightly below the null in the simvastatin + ezetimibe example, and results substantially below the null in the COX-2 inhibitor example (18)(19)(20)(21).…”

Comparative safety and effectiveness of alendronate versus raloxifene in women with osteoporosis

“…Prevailing clinical wisdom favors alendronate as the first-line treatment option for osteoporosis patients against fracture [26][27][28][29][30] . However, head-to-head randomized studies of alendronate vs raloxifene have only shown increased bone mineral density with alendronate 31,32 , which do not necessarily relate to clinically observed fracture risk 6,9 .…”

“…The bisphosphonate alendronate and the selective estrogen receptor modulator (SERM) raloxifene are among the most popular antiresorptive agents for the prevention and treatment of postmenopausal osteoporosis 6,7 . Based on existing randomized studies that compare alendronate and raloxifene separately to placebo 8,9 , alendronate seems to have superior fracture prevention benefits.…”