Bone anabolic treatments reduce fractures to a greater extent than bisphosphonates in women at high risk

Référence

Händel MN, Cardoso I, von Bülow C, et al. Fracture risk reduction and safety by osteoporosis treatment compared with placebo or active comparator in postmenopausal women: systematic review, network meta-analysis, and meta-regression analysis of randomised clinical trials. BMJ 2023;381:e068033.

Sommaire

Searching 3 databases, including Cochrane CENTRAL, these investigators identified 69 randomized controlled trials that enrolled more than 80,000 postmenopausal women. Two researchers independently selected studies for inclusion, and data were extracted and compared by 2 researchers. Because of low study quality (mainly incomplete description of the method of randomization and whether allocation to treatment group was concealed from enrolling investigators), the certainty of the findings was low. The researchers used a network meta-analysis to compare results among treatments even when they weren't directly compared. There was no evidence of publication bias. Of the 34 studies that reported on overall fracture risk, teriparatide and abaloparatide were more effective than bisphosphonates such as alendronate, risedronate, or denosumab (Prolia). For hip fracture prevention, teriparatide, abaloparatide, denosumab, and romosozumab (Evenity) were all more effective than bisphosphonates. The relative benefit for any prevention is small, though: For every 1000 women treated, there will be 3 to 39 fewer fractures of any type.