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

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.

Zoledronic Acid in Osteoporotic Vertebral Compression Fractures Treated With Percutaneous Kyphoplasty: A Meta-Analysis

“…The administration of BPs as anti-osteoporotic drugs has been confirmed to effectively prevent bone loss and increase bone quality and density. Several studies have verified that BPs decrease the risk of vertebral and non-vertebral fractures (5,24). The present meta-analysis revealed that zoledronic acid not only significantly improved post-operative BMD at 6 and 12 months but also decreased the incidence of additional vertebral body fractures.…”

Bisphosphonate therapy after liver transplant improves bone mineral density and reduces fracture rates: an updated systematic review and meta‐analysis

“…[37] studying IV zoledronic acid versus oral risedronate in the prevention and treatment of glucocorticoid‐induced osteoporosis, zoledronic acid was reported to be more efficacious than risedronate in increasing the lumbar spine BMD at 12 months. A recent network meta‐analysis concluded that oral alendronate was the most efficacious among five commonly used bisphosphonates (alendronate, risedronate, ibandronate, zoledronate, and etidronate) in preventing vertebral and hip fractures, while zoledronic acid was most efficacious in preventing nonvertebral nonhip fractures [38].…”

Effect of Bisphosphonate on Hip Fracture in Patients with Osteoporosis or Osteopenia According to age: A Meta-Analysis and Systematic Review

“…In recent years, there have been some meta-analyses and systematic reviews that included the effects of bisphosphonates on the IHF. In these meta-analyses and systematic reviews, bisphosphonates significantly reduced the IHF; however, none of them reported results stratified according to patient age or the kind of bisphosphonate used 1–3 30…”