Pharmacological Therapies for Osteoporosis: A Bayesian Network Meta-Analysis

Shen, Jiping; Ke, Zheng; Dong, Shuangshuang; Lv, Minzhi; Yuan, Ying; Song, Liang‐Nian; Wu, Kefen; Xu, Kan; Hu, Yu

doi:10.12659/msm.935491

Cited by 6 publications

(6 citation statements)

References 126 publications

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“…Bisphosphonates may also be used to prevent osteoporosis in persons without high fracture risk, including those with a T-score between -1 and -2.5 whose risk assessments do not indicate high fracture risk but who desire pharmacologic therapy to prevent bone loss or fracture. 29 All oral bisphosphonates should be avoided in patients with dysphagia, esophageal motility disorders, or the inability to stand or sit upright for at least 30 minutes. Hypocalcemia and vitamin D deficiency should be corrected prior to starting treatment with bisphosphonates.…”

Section: Bisphosphonatesmentioning

confidence: 99%

“…Risk reduction should always be stressed as well 4. A 2022 meta-analysis found that romosozumab had the best results in terms of reducing fracture risk for all fractures, and abaloparatide was the most efficacious in decreasing vertebral and nonvertebral fracture risk 29…”

Section: Pharmacologic Treatmentmentioning

confidence: 99%

“…Bisphosphonates are indicated for persons at high fracture risk, including those with history of fragility fracture; males age 50 years or older and postmenopausal females with a T-score of -2.5 or lower; or those with a T-score between -1 and -2.5 at high fracture risk as determined through risk assessment. Bisphosphonates may also be used to prevent osteoporosis in persons without high fracture risk, including those with a T-score between -1 and -2.5 whose risk assessments do not indicate high fracture risk but who desire pharmacologic therapy to prevent bone loss or fracture 29…”

Section: Pharmacologic Treatmentmentioning

confidence: 99%

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Osteoporosis management in primary care

Jarrell

2023

The Nurse Practitioner

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Osteoporosis is the most prevalent bone disease in the US. Once diagnosed, osteoporosis requires ongoing management; therefore, primary care providers are vital in managing both primary and secondary fracture prevention. Safe, efficacious, and economical medications are available, but osteoporosis remains underdiagnosed and undertreated. Bisphosphonates, selective estrogen receptor modulators (raloxifene), conjugated estrogens/bazedoxifene, estrogen therapy/hormone therapy, parathyroid hormone analogues, RANK ligand inhibitors (denosumab), sclerostin inhibitors (romosozumab), and calcitonin are all drugs or drug classes commonly used to treat osteoporosis that are discussed in this article.

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Section: Bisphosphonatesmentioning

confidence: 99%

Section: Pharmacologic Treatmentmentioning

confidence: 99%

Section: Pharmacologic Treatmentmentioning

confidence: 99%

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Osteoporosis management in primary care

Jarrell

2023

The Nurse Practitioner

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“…Numerous pharmacological therapies have been proposed to reduce fracture risk in patients with osteoporosis. In a recent network meta-analysis including 108,797 individuals from 79 randomized controlled trials, Shen et al reported that pharmacological therapies like alendronate zolendronate, risedronate, ibandronate, denosumab, abaloparatide, teriparatide and romosozumab were all effective treatments to reduce the risk of fractures [ 11 ]. The majority (i.e.…”

Section: Introductionmentioning

confidence: 99%

“…86%) of the trials included in this meta-synthesis sampled postmenopausal women. As a considerable amount of evidence is convergent regarding the efficacy of the above-mentioned therapies in women [ 11 – 15 ], it is now accepted from regulatory agencies to grant marketing authorization of these drugs for men with osteoporosis following the conduct of bridging studies [ 16 , 17 ]. In these studies, the primary outcome is no longer the risk of fracture but rather an increase of bone mineral density (BMD) similar to that observed in women [ 18 , 19 ].…”

Section: Introductionmentioning

confidence: 99%

Efficacy of osteoporosis pharmacological treatments in men: a systematic review and meta-analysis

et al. 2023

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Introduction The objective of this systematic review and meta-analysis is to systematically identify and review the efficacy of pharmacological treatments in men with osteoporosis. Methods Medline (via Ovid) and Cochrane CENTRAL were searched up to May 2023 for any randomized controlled trial (RCT) evaluating the efficacy of osteoporotic treatment on the evolution of Bone Mineral Density (BMD) and incidence of fractures of men suffering from primary osteoporosis. If at least two studies used the same pharmacological treatment and evaluated the same outcome, a random effect model meta-analysis was applied to reported pooled mean difference (MD) and 95% confidence interval (CI). Results From the 1,061 studies identified through bibliographic search, 21 RCTs fitted the inclusion criteria. Bisphosphonates (k = 10, n = 2992 men with osteoporosis) improved all three BMD sites compared to placebo; lumbar spine: MD + 4.75% (95% CI 3.45, 6.05); total hip: MD + 2.72% (95% CI 2.06; 3.37); femoral neck: MD + 2.26% (95% CI 1.67; 2.85). Denososumab (k = 2, n = 242), Teriparatide (k = 2, n = 309) and Abaloparatide (k = 2, n = 248) also produced significant improvement of all sites BMD compared to placebo. Romosozumab was only identified in one study and was therefore not meta-analysed. In this study, Romosozumab increased significantly BMD compared to placebo. Incident fractures were reported in 16 RCTs but only four reported fractures as the primary outcome. Treatments were associated with a lower incidence of fractures. Conclusions Medications used in the management of osteoporosis in women appear to provide similar benefits in men with osteoporosis. Therefore, the algorithm for the management of osteoporosis in men could be similar to the one previously recommended for the management of osteoporosis in women.

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Chronic kidney disease promotes atrial fibrillation via inflammasome pathway activation

Song¹,

Navarro‐García²,

Wu³

et al. 2023

Journal of Clinical Investigation

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Chronic kidney disease (CKD) is associated with a higher risk of atrial fibrillation (AF). The mechanistic link between CKD and AF remains elusive. IL-1β, a main effector of NLR family pyrin domain–containing 3 (NLRP3) inflammasome activation, is a key modulator of conditions associated with inflammation, such as AF and CKD. Circulating IL-1β levels were elevated in patients with CKD who had AF (versus patients with CKD in sinus rhythm). Moreover, NLRP3 activity was enhanced in atria of patients with CKD. To elucidate the role of NLRP3/IL-1β signaling in the pathogenesis of CKD-induced AF, Nlrp3 –/– and WT mice were subjected to a 2-stage subtotal nephrectomy protocol to induce CKD. Four weeks after surgery, IL-1β levels in serum and atrial tissue were increased in WT CKD (WT-CKD) mice versus sham-operated WT (WT-sham) mice. The increased susceptibility to pacing-induced AF and the longer AF duration in WT-CKD mice were associated with an abbreviated atrial effective refractory period, enlarged atria, and atrial fibrosis. Genetic inhibition of NLRP3 in Nlrp3 –/– mice or neutralizing anti–IL-1β antibodies effectively reduced IL-1β levels, normalized left atrial dimensions, and reduced fibrosis and the incidence of AF. These data suggest that CKD creates a substrate for AF development by activating the NLRP3 inflammasome in atria, which is associated with structural and electrical remodeling. Neutralizing IL-1β antibodies may be beneficial in preventing CKD-induced AF.

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Pharmacological Therapies for Osteoporosis: A Bayesian Network Meta-Analysis

Cited by 6 publications

References 126 publications

Osteoporosis management in primary care

Osteoporosis management in primary care

Efficacy of osteoporosis pharmacological treatments in men: a systematic review and meta-analysis

Chronic kidney disease promotes atrial fibrillation via inflammasome pathway activation

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