Full Article
Evidence Summary
What is an Evidence Summary?
Key messages from scientific research that's ready to be acted on
Got It, Hide thisIn women with osteoporosis, denosumab, teriparatide, and some bisphosphonates reduce spinal and non-spinal fractures
Crandall CJ, Newberry SJ, Diamant A, et al. Comparative Effectiveness of Pharmacologic Treatments to Prevent Fractures: An Updated Systematic Review. Ann Intern Med. 2014;161:711-23.
Review questions
In people with osteoporosis, do drugs prevent fractures (bone breaks)? Are some drugs better than others? What are the side-effects of drugs?
Background
Osteoporosis weakens your bones and makes them more likely to fracture, often at the hip, spine, or wrist. Anyone can get osteoporosis. Drugs may prevent fractures, although they also have side-effects.
How the review was done
The researchers did a systematic review, searching for studies that were published in English up to March 2014.
They found 294 studies, including systematic reviews, randomized controlled trials, and nonrandomized studies.
The key features of the randomized trials were:
- people had osteoporosis that was not caused by other treatments;
- drugs were bisphosphonates (alendronate [Binosto®, Fosamax®], ibandronate [Boniva®, Bondronat®], risedronate [Actonel®, Atelvia®], or zoledronic acid [Reclast®, Zometa®]), denosumab (Prolia®, Xgeva®), teriparatide (Forteo®, Parathar®), or raloxifene (Evista®, keoxifene);
- drugs were compared with one another or placebo; and
- people were followed-up for at least 6 months.
What the researchers found
Compared with placebo:
- alendronate, risedronate, zoledronic acid, denosumab, and teriparatide reduced spinal and non-spinal fractures in women;
- ibandronate and raloxifene reduced spinal fractures in women; and
- data in men are sparse, but zoledronic acid reduced spinal fractures in men.
There wasn’t enough information to determine if some drugs were better than others.
The drugs had different side-effects.
Conclusions
In women with osteoporosis, alendronate, risedronate, zoledronic acid, denosumab, and teriparatide reduce spinal and non-spinal fractures, and ibandronate and raloxifene reduce spinal fractures. The drugs have different side-effects. In men, zoledronic acid reduced spinal fractures.
Benefits and harms of drugs for preventing fractures in people with osteoporosis
| Outcomes | Drugs | Comparison | Absolute effect of drugs | Strength of evidence* |
| Spinal fractures in women | Alendronate, ibandronate, risedronate, zoledronic acid, denosumab, teriparatide, raloxifene | Placebo | About 11 to 17 fewer women out of 1,000 had spinal fractures | Strong |
| Non-spinal fractures in women | Alendronate, risedronate, zoledronic acid, denosumab, teriparatide | Placebo | About 15 to 20 fewer women out of 1,000 had non-spinal fractures | Strong |
|
| Raloxifene | Placebo | No effect | Not reported |
| Spinal fractures in men | Zoledronic acid | Placebo | About 33 fewer men out of 1,000 had spinal fractures | Moderate – just 1 study |
| SIDE-EFFECTS |
|
|
|
|
| Mild upper-gastrointestinal symptoms | Bisphosphonates, denosumab, teriparatide | Not reported | About 72 to 956 events in 1,000 people | Strong |
| Atypical fracture of the thigh bone | Bisphosphonates | Not reported | About 2 to 100 events in 100,000 women | Low |
| Osteonecrosis (loss) of the bone of the jaw | Bisphosphonates | Not reported | Fewer than 1 to about 43 people out of 1,000 had events | Low |
| Influenza-like symptoms | Zoledronic acid | Not reported | About 728 to 896 events in 1,000 people | Strong |
| Hypocalcemia (low calcium levels in blood) | Zoledronic acid | Not reported | About 5 to 118 events in 1,000 people | Strong |
| Infection | Denosumab | Not reported | About 8 more people out of 1,000 had infections | Moderate |
| Hypercalcemia (high calcium levels in blood) | Teriparatide | Not reported | About 537 to 820 events in 1,000 people | Strong |
| Headache | Teriparatide | Not reported | About 511 to 679 events in 1,000 people | Strong |
| Hot flashes or thromboembolic events | Raloxifene | Not reported | About 24 to 35 events in 1,000 people | Strong |
Related Topics
Glossary
Related to the stomach and the intestines (bowels).
A harmless, inactive, and simulated treatment.
Studies where people are assigned to one of the treatments purely by chance.
A comprehensive evaluation of the available research evidence on a particular topic.
Related Evidence Summaries
-
Nutritional strategies can improve body composition in underweight and overweight older adults
JBI Database of Systematic Reviews and Implementation Reports (2016)
-
Exercise alone, and in combination with different fall prevention strategies may lower the risk of falls leading to injuries in older adults 65 and over
JAMA: Journal of the American Medical Association (2017)
-
Innovative hip and knee replacement devices do not improve function more than conventional devices and may increase need for revision surgery
BMJ (2014)
