Efficacy of Pharmacological Therapies for the Prevention of Fractures in Postmenopausal Women: A Network Meta-Analysis

Patricia Barrionuevo, Ekta Kapoor, Noor Asi, Fares Alahdab, Khaled Mohammed, Khalid Benkhadra, Jehad Almasri, Wigdan Farah, Maria Sarigianni, Kalpana Muthusamy, Alaa Al Nofal, Qusay Haydour, Zhen Wang, Mohammad H Murad

Research output: Contribution to journalArticle

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Abstract

BACKGROUND: Osteoporosis and osteopenia are associated with increased fracture incidence in postmenopausal women. We aimed to determine the comparative effectiveness of various available pharmacological therapies. METHODS: We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, ISI Web of Science, and Scopus for randomized controlled trials that enrolled postmenopausal women with primary osteoporosis and evaluated the risk of hip, vertebral, or nonvertebral fractures. A network meta-analysis was conducted using the multivariate random effects method. RESULTS: We included 107 trials (193,987 postmenopausal women; mean age, 66 years; 55% white; median follow-up, 28 months). A significant reduction in hip fractures was observed with romosozumab, alendronate, zoledronate, risedronate, denosumab, estrogen with progesterone, and calcium in combination with vitamin D. A significant reduction in nonvertebral fractures was observed with abaloparatide, romosozumab, denosumab, teriparatide, alendronate, risedronate, zoledronate, lasofoxifene, tibolone, estrogen with progesterone, and vitamin D. A significant reduction in vertebral fractures was observed with abaloparatide, teriparatide, parathyroid hormone 1-84, romosozumab, strontium ranelate, denosumab, zoledronate, risedronate, alendronate, ibandronate, raloxifene, bazedoxifene, lasofoxifene, estrogen with progesterone, tibolone, and calcitonin. Teriparatide, abaloparatide, denosumab, and romosozumab were associated with the highest relative risk reductions, whereas ibandronate and selective estrogen receptor modulators had lower efficacy. The evidence for the treatment of fractures with vitamin D and calcium remains limited despite numerous large trials. CONCLUSIONS: This network meta-analysis provides comparative effective estimates for the various available treatments to reduce the risk of fragility fractures in postmenopausal women.

Original languageEnglish (US)
Pages (from-to)1623-1630
Number of pages8
JournalThe Journal of clinical endocrinology and metabolism
Volume104
Issue number5
DOIs
StatePublished - May 1 2019

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zoledronic acid
tibolone
Teriparatide
Alendronate
Vitamin D
Pharmacology
Progesterone
Estrogens
strontium ranelate
Osteoporosis
Calcium
Selective Estrogen Receptor Modulators
Metabolic Bone Diseases
Hip Fractures
Calcitonin
Risk Reduction Behavior
Therapeutics
Parathyroid Hormone
MEDLINE
Hip

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Biochemistry
  • Endocrinology
  • Clinical Biochemistry
  • Biochemistry, medical

Cite this

Efficacy of Pharmacological Therapies for the Prevention of Fractures in Postmenopausal Women : A Network Meta-Analysis. / Barrionuevo, Patricia; Kapoor, Ekta; Asi, Noor; Alahdab, Fares; Mohammed, Khaled; Benkhadra, Khalid; Almasri, Jehad; Farah, Wigdan; Sarigianni, Maria; Muthusamy, Kalpana; Al Nofal, Alaa; Haydour, Qusay; Wang, Zhen; Murad, Mohammad H.

In: The Journal of clinical endocrinology and metabolism, Vol. 104, No. 5, 01.05.2019, p. 1623-1630.

Research output: Contribution to journalArticle

Barrionuevo, P, Kapoor, E, Asi, N, Alahdab, F, Mohammed, K, Benkhadra, K, Almasri, J, Farah, W, Sarigianni, M, Muthusamy, K, Al Nofal, A, Haydour, Q, Wang, Z & Murad, MH 2019, 'Efficacy of Pharmacological Therapies for the Prevention of Fractures in Postmenopausal Women: A Network Meta-Analysis', The Journal of clinical endocrinology and metabolism, vol. 104, no. 5, pp. 1623-1630. https://doi.org/10.1210/jc.2019-00192
Barrionuevo, Patricia ; Kapoor, Ekta ; Asi, Noor ; Alahdab, Fares ; Mohammed, Khaled ; Benkhadra, Khalid ; Almasri, Jehad ; Farah, Wigdan ; Sarigianni, Maria ; Muthusamy, Kalpana ; Al Nofal, Alaa ; Haydour, Qusay ; Wang, Zhen ; Murad, Mohammad H. / Efficacy of Pharmacological Therapies for the Prevention of Fractures in Postmenopausal Women : A Network Meta-Analysis. In: The Journal of clinical endocrinology and metabolism. 2019 ; Vol. 104, No. 5. pp. 1623-1630.
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T2 - A Network Meta-Analysis

AU - Barrionuevo, Patricia

AU - Kapoor, Ekta

AU - Asi, Noor

AU - Alahdab, Fares

AU - Mohammed, Khaled

AU - Benkhadra, Khalid

AU - Almasri, Jehad

AU - Farah, Wigdan

AU - Sarigianni, Maria

AU - Muthusamy, Kalpana

AU - Al Nofal, Alaa

AU - Haydour, Qusay

AU - Wang, Zhen

AU - Murad, Mohammad H

PY - 2019/5/1

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N2 - BACKGROUND: Osteoporosis and osteopenia are associated with increased fracture incidence in postmenopausal women. We aimed to determine the comparative effectiveness of various available pharmacological therapies. METHODS: We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, ISI Web of Science, and Scopus for randomized controlled trials that enrolled postmenopausal women with primary osteoporosis and evaluated the risk of hip, vertebral, or nonvertebral fractures. A network meta-analysis was conducted using the multivariate random effects method. RESULTS: We included 107 trials (193,987 postmenopausal women; mean age, 66 years; 55% white; median follow-up, 28 months). A significant reduction in hip fractures was observed with romosozumab, alendronate, zoledronate, risedronate, denosumab, estrogen with progesterone, and calcium in combination with vitamin D. A significant reduction in nonvertebral fractures was observed with abaloparatide, romosozumab, denosumab, teriparatide, alendronate, risedronate, zoledronate, lasofoxifene, tibolone, estrogen with progesterone, and vitamin D. A significant reduction in vertebral fractures was observed with abaloparatide, teriparatide, parathyroid hormone 1-84, romosozumab, strontium ranelate, denosumab, zoledronate, risedronate, alendronate, ibandronate, raloxifene, bazedoxifene, lasofoxifene, estrogen with progesterone, tibolone, and calcitonin. Teriparatide, abaloparatide, denosumab, and romosozumab were associated with the highest relative risk reductions, whereas ibandronate and selective estrogen receptor modulators had lower efficacy. The evidence for the treatment of fractures with vitamin D and calcium remains limited despite numerous large trials. CONCLUSIONS: This network meta-analysis provides comparative effective estimates for the various available treatments to reduce the risk of fragility fractures in postmenopausal women.

AB - BACKGROUND: Osteoporosis and osteopenia are associated with increased fracture incidence in postmenopausal women. We aimed to determine the comparative effectiveness of various available pharmacological therapies. METHODS: We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, ISI Web of Science, and Scopus for randomized controlled trials that enrolled postmenopausal women with primary osteoporosis and evaluated the risk of hip, vertebral, or nonvertebral fractures. A network meta-analysis was conducted using the multivariate random effects method. RESULTS: We included 107 trials (193,987 postmenopausal women; mean age, 66 years; 55% white; median follow-up, 28 months). A significant reduction in hip fractures was observed with romosozumab, alendronate, zoledronate, risedronate, denosumab, estrogen with progesterone, and calcium in combination with vitamin D. A significant reduction in nonvertebral fractures was observed with abaloparatide, romosozumab, denosumab, teriparatide, alendronate, risedronate, zoledronate, lasofoxifene, tibolone, estrogen with progesterone, and vitamin D. A significant reduction in vertebral fractures was observed with abaloparatide, teriparatide, parathyroid hormone 1-84, romosozumab, strontium ranelate, denosumab, zoledronate, risedronate, alendronate, ibandronate, raloxifene, bazedoxifene, lasofoxifene, estrogen with progesterone, tibolone, and calcitonin. Teriparatide, abaloparatide, denosumab, and romosozumab were associated with the highest relative risk reductions, whereas ibandronate and selective estrogen receptor modulators had lower efficacy. The evidence for the treatment of fractures with vitamin D and calcium remains limited despite numerous large trials. CONCLUSIONS: This network meta-analysis provides comparative effective estimates for the various available treatments to reduce the risk of fragility fractures in postmenopausal women.

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