Dennis M. Black, PhD; Steven Boonen, MD, PhD; Pierre Delmas, MD, PhD; Kenneth W. Lyles, MD
Potential Financial Conflicts of Interest:Research contracts: D. Black (Novartis, Merck), K. Lyles (Novartis, Alliance for Better Bone Health, Amgen). Consultancies: P. Delmas (Novartis), K. Lyles (Novartis, Procter & Gamble, Merck, Amgen, GTx, Eli Lilly, GlaxoSmithKline, Bone Medical Ltd.) S. Boonen (Amgen, Aventis Pharmaceuticals, Celtrix Pharmaceuticals, Eli Lilly, GlaxoSmithKline, Insmed Pharmaceuticals, Institut de Recherches Internationales Servier, Merck Sharp & Dohme, Novartis Pharmaceuticals, Nycomed, Pfizer, Roche Pharmaceuticals, Sanofi-Aventis). Patents received: K. Lyles (20050272707).
Black DM, Boonen S, Delmas P, Lyles KW. Review of Comparative Effectiveness of Treatments to Prevent Fractures. Ann Intern Med. 2008;148:885-886. doi: 10.7326/0003-4819-148-11-200806030-00019
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Published: Ann Intern Med. 2008;148(11):885-886.
TO THE EDITOR:
The meta-analysis by MacLean and colleagues (1) is interesting and comprehensive, but we question 1 methodological aspect: the use of previous meta-analyses and their combination with individual trials. The Methods section is unclear as to how previous meta-analyses were chosen or combined, and this may have led to inconsistent results. For example, for alendronate, 2 meta-analyses are listed for patients who are at high risk (defined in Table 1) for hip fracture (Table 4). One meta-analysis includes 2 trials in high-risk patients. The other includes 6 trials: 2 overlap with the first meta-analysis, whereas the other 4 do not meet the authors' high-risk criteria. How were these 2 meta-analyses combined and the non–high-risk studies incorporated in order to achieve the overall assessment? We suggest that greater consistency and clarity would be gained in building meta-analyses from relevant individual trials.
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