Catherine MacLean, MD, PhD; Margaret Maglione, MPP; Marika Suttorp, MS
Potential Financial Conflicts of Interest: None disclosed.
MacLean C, Maglione M, Suttorp M. Review of Comparative Effectiveness of Treatments to Prevent Fractures. Ann Intern Med. 2008;148:887. doi: 10.7326/0003-4819-148-11-200806030-00021
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Published: Ann Intern Med. 2008;148(11):887.
Dr. Rosen is correct. The study he references (1) was included in our analysis but was not called out in the section on renal insufficiency. This trial reported the effect of risedronate on fractures among participants with varying degrees of renal insufficiency. This study, which combined data from 9 randomized, double-blind, placebo-controlled trials, reported a reduced incidence of vertebral fractures with risedronate compared with placebo in participants with severe, moderate, and mild renal insufficiency.
Although not reported in our paper, we did collect data and calculate pooled estimates for all adverse events reported in all studies reviewed. Details on musculoskeletal and other adverse events can be found in the appendices to the full report (2). We identified between 1 and 3 studies that compared the effect of alendronate, ibandronate, pamidronate, risedronate, and zoledronic acid on myalgias, cramps, or leg pain. Statistically significant risks were observed for ibandronate (2.25 [CI, 1.57 to 3.29]) and zoledronic acid (3.67 [CI, 2.01 to 7.18]) compared with placebo.
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