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Bone anabolic treatments reduce fractures to a greater extent than bisphosphonates in women at high risk
Clinical Question
Which treatments are most effective to prevent fractures in postmenopausal women?
Bottom line
Bisphosphonates trailed other approaches to prevent osteoporosis in this network meta-analysis. The parathyroid hormone receptor agonists teriparatide (Forteo, Forsteo) and abaloparatide (Tymlos, Eladynos) are slightly more effective to prevent overall fractures and hip fractures, though all treatments are more effective than placebo. 1a-
Reference
Study design: Meta-analysis (randomized controlled trials)
Funding: Industry + foundation
Setting: Various (meta-analysis)
Synopsis
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.
Reviewer
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA
Comments
Women at high risk?
Not enough information. I'd like to know what is their definition of a postmenopausal woman at high risk.
Impact assessment
Excellent
BOME METABOLISM AND ANABOLIC STEROID
HELPFUL
Cost analysis
I would have liked to see a comment on whether or not there was a cost analysis between the bone anabolics and bisphosphonates, and relevant commentary if not.