Assessing the Effectiveness of Bisphosphonates for the Prevention of Fragility Fractures: An Updated Systematic Review and Network Meta‐Analyses

JBMR Plus

Neil Gittoes¹  Anastasios Bastounis²  Tessa Langley²  Jo Leonardi‐Bee²  Opinder Sahota³  Sarah Davis⁴  Zoe Paskins⁵ 

[1] Centre for Endocrinology, Diabetes and Metabolism (CEDAM) University of Birmingham Birmingham UK;Division of Epidemiology & Public Health, School of Medicine University of Nottingham, City Hospital Nottingham UK;Queens Medical Centre (QMC), University of Nottingham Nottingham University Hospitals NHS Trust Nottingham UK;School of Health and Related Research, Regent Court (ScHARR) University of Sheffield Sheffield UK;School of Medicine Keele University Keele UK;

关键词: ANTIRESORPTIVES;    BISPHOSPHONATES;    FRACTURE PREVENTION;    FRACTURES;    INJURY/FRACTURE HEALING;    NETWORK META‐ANALYSIS;   

DOI  :  10.1002/jbm4.10620

来源: DOAJ

【 摘 要 】

ABSTRACT Bisphosphonates have been found to be effective in preventing fragility fractures. However, their comparative effectiveness in populations at risk has yet to be defined. In light of recent clinical trials, we aimed to compare four bisphosphonates (alendronate, ibandronate, risedronate, and zoledronate) and to identify which are the most effective for the prevention of fragility fractures. This is an update of a systematic review previously published as part of a NICE HTA report. We conducted a systematic review and network meta‐analysis, updating the estimates regarding the comparative effectiveness of the aforementioned bisphosphonates. Studies identified from published and unpublished sources between 2014 and 2021 were added to the studies identified in the previous review. Screening, data extraction and risk of bias assessment were independently undertaken by two reviewers. Outcomes were fractures, femoral neck bone mineral density (BMD), mortality, and adverse events. We identified 25 additional trials, resulting in a total population of 47,007 participants. All treatments had beneficial effects on fractures versus placebo with zoledronate being the most effective treatment in preventing vertebral fractures (hazard ratio [HR] 0.38; 95% credibility interval [CrI], 0.28–0.49). Zoledronate (HR 0.71; 95% CrI, 0.61–0.81) and risedronate (HR 0.70; 95% CrI, 0.53–0.84) were found to be the most effective treatments in preventing nonvertebral fractures. All treatments were associated with increases in femoral neck BMD versus placebo with zoledronate being the most effective treatment mean difference (MD 4.02; 95% CrI, 3.2–4.84). There was a paucity of data regarding hip and wrist fractures. Depending on its cost‐effectiveness, zoledronate could be considered a first‐line option for people at increased risk of fragility fractures. © 2022 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

【 授权许可】

Unknown