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
Authors' conclusion
The evidence indicated a benefit of a range of treatments for osteoporosis in postmenopausal women for clinical and vertebral fractures. Bone anabolic treatments were more effective than bisphosphonates in the prevention of clinical and vertebral fractures, irrespective of baseline risk indicators.
Study context
- Population
- Non-Asian postmenopausal women, no age restriction; RCTs published 1 January 1996 to 24 November 2021
- Participants
- >80,000 women69 trials
- Comparison
- Osteoporosis treatments vs placebo or active comparator
- Outcome
- Clinical fractures
Pooled result
As reported in the abstract
Odds ratio (95% CI)
Bisphosphonatesvs Parathyroid hormone receptor agonistsbisphosphonates less effective
1.49(1.12–2.00)
Denosumabvs Parathyroid hormone receptor agonistsdenosumab less effective
1.85(1.18–2.92)
Denosumabvs Romosozumabdenosumab less effective
1.56(1.02–2.39)
Further pooled results
| Outcome | β (95% CI) |
|---|---|
| Clinical fractures vs placebo with increasing mean age (antiresorptive treatments, meta-regression)17 studies; greater reduction with increasing mean age | 0.98 (0.96–0.99) |
Vertebral fractures
- Effect of all treatments vs placebo
- Denosumab, PTH receptor agonists and romosozumab more effective than oral bisphosphonates
Clinical fractures vs placebo with increasing mean age (antiresorptive treatments, meta-regression)
- Effect of all treatments otherwise unaffected by baseline risk indicators
Safety
- No harm outcomes were seen
Original publication
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. Published 2 May 2023. doi:10.
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