In women with osteoporosis, denosumab, teriparatide, and some bisphosphonates reduce spinal and non-spinal fractures

Crandall CJ, Newberry SJ, Diamant A, et al. Comparative Effectiveness of Pharmacologic Treatments to Prevent Fractures: An Updated Systematic Review. Ann Intern Med. 2014;161:711-23.

Review questions

In people with osteoporosis, do drugs prevent fractures (bone breaks)? Are some drugs better than others? What are the side-effects of drugs?

Background

Osteoporosis weakens your bones and makes them more likely to fracture, often at the hip, spine, or wrist. Anyone can get osteoporosis. Drugs may prevent fractures, although they also have side-effects.

How the review was done

The researchers did a systematic review, searching for studies that were published in English up to March 2014.

They found 294 studies, including systematic reviews, randomized controlled trials, and nonrandomized studies.

The key features of the randomized trials were:

• people had osteoporosis that was not caused by other treatments;
• drugs were bisphosphonates (alendronate [Binosto®, Fosamax®], ibandronate [Boniva®, Bondronat®], risedronate [Actonel®, Atelvia®], or zoledronic acid [Reclast®, Zometa®]), denosumab (Prolia®, Xgeva®), teriparatide (Forteo®, Parathar®), or raloxifene (Evista®, keoxifene);
• drugs were compared with one another or placebo; and
• people were followed-up for at least 6 months.

What the researchers found

Compared with placebo:

• alendronate, risedronate, zoledronic acid, denosumab, and teriparatide reduced spinal and non-spinal fractures in women;
• ibandronate and raloxifene reduced spinal fractures in women; and
• data in men are sparse, but zoledronic acid reduced spinal fractures in men.

There wasn’t enough information to determine if some drugs were better than others.

The drugs had different side-effects.

Conclusions

In women with osteoporosis, alendronate, risedronate, zoledronic acid, denosumab, and teriparatide reduce spinal and non-spinal fractures, and ibandronate and raloxifene reduce spinal fractures. The drugs have different side-effects. In men, zoledronic acid reduced spinal fractures.

Benefits and harms of drugs for preventing fractures in people with osteoporosis

*Based on Agency for Healthcare Research and Quality criteria.