Carolyn J. Crandall, MD, MS; Sydne J. Newberry, PhD; Allison Diamant, MD, MSHS; Yee-Wei Lim, MD, PhD; Walid F. Gellad, MD, MPH; Marika J. Booth, MS; Aneesa Motala, BA; Paul G. Shekelle, MD, PhD
Acknowledgment: The authors acknowledge Roberta Shanman, MLS, for conducting the update searches and Kanaka Shetty, MD, and Michael Scarpati, PhD, for the use of machine learning for the 2013 update searches. In addition, they acknowledge the guidance provided by the technical expert panel members, Roberta Biegel, MA; Bruce Ettinger, MD; Theodore Hahn, MD; Marc Hochberg, MD, MPH; Hau Liu, MD; Catherine MacLean, MD, PhD; Paul Miller, MD; Eric Orwoll, MD; Marcel E. Salive, MD, MPH; and Daniel Solomon, MD, MPH.
Grant Support: By the Agency for Healthcare Research and Quality (AHRQ) (HHSA290200710062I). No statement in this article should be construed as an official position of AHRQ or the U.S. Department of Health and Human Services.
Disclosures: All authors received grant support from AHRQ during the conduct of the study. Dr. Gellad reports grant support from Express Scripts outside the submitted work. Dr. Shekelle reports royalties from UpToDate outside the submitted work and was an author of an American College of Physicians guideline on this topic. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-0317.
Requests for Single Reprints: Carolyn J. Crandall, MD, MS, Professor of Medicine, David Geffen School of Medicine, Division of General Internal Medicine & Health Services Research, University of California, Los Angeles, 911 Broxton Avenue, 1st Floor, Los Angeles, CA 90024; e-mail, firstname.lastname@example.org.
Current Author Addresses: Drs. Crandall and Diamant: David Geffen School of Medicine, Division of General Internal Medicine & Health Services Research, University of California, Los Angeles, 911 Broxton Avenue, 1st Floor, Los Angeles, CA 90024.
Dr. Newberry, Ms. Booth, and Ms. Motala: RAND Corporation, 1776 Main Street, Santa Monica, CA 90401.
Dr. Lim: Saw Swee Hock School of Public Health, National University of Singapore, Singapore MD3, 16 Medical Drive, Singapore 117597.
Dr. Gellad: Pittsburgh Veterans Affairs Medical Center and the Center for Health Equity Research and Promotion, University Drive, Pittsburgh, PA 15240.
Dr. Shekelle: Veterans Affairs Los Angeles Healthcare System, 11301 Wilshire Boulevard, Los Angeles, CA 90073.
Author Contributions: Conception and design: C.J. Crandall, S.J. Newberry, A. Diamant, Y.W. Lim, P.G. Shekelle.
Analysis and interpretation of the data: C.J. Crandall, S.J. Newberry, A. Diamant, Y.W. Lim, W.F. Gellad, M.J. Booth, P.G. Shekelle.
Drafting of the article: C.J. Crandall, S.J. Newberry, A. Diamant, M.J. Booth, A. Motala, P.G. Shekelle.
Critical revision of the article for important intellectual content: C.J. Crandall, S.J. Newberry, A. Diamant, W.F. Gellad, P.G. Shekelle.
Final approval of the article: C.J. Crandall, S.J. Newberry, A. Diamant, W.F. Gellad, P.G. Shekelle.
Statistical expertise: M.J. Booth.
Obtaining of funding: P.G. Shekelle.
Administrative, technical, or logistic support: A. Motala, P.G. Shekelle.
Collection and assembly of data: S.J. Newberry, A. Diamant, Y.W. Lim, W.F. Gellad, A. Motala, M.J. Booth, P.G. Shekelle.
Osteoporosis is a major contributor to the propensity to fracture among older adults, and various pharmaceuticals are available to treat it.
To update a review about the benefits and harms of pharmacologic treatments used to prevent fractures in adults at risk.
Multiple computerized databases were searched between 2 January 2005 and 4 March 2014 for English-language studies.
Trials, observational studies, and systematic reviews.
Duplicate extraction and assessment of data about study characteristics, outcomes, and quality.
From more than 52 000 titles screened, 315 articles were included in this update. There is high-strength evidence that bisphosphonates, denosumab, and teriparatide reduce fractures compared with placebo, with relative risk reductions from 0.40 to 0.60 for vertebral fractures and 0.60 to 0.80 for nonvertebral fractures. Raloxifene has been shown in placebo-controlled trials to reduce only vertebral fractures. Since 2007, there is a newly recognized adverse event of bisphosphonate use: atypical subtrochanteric femur fracture. Gastrointestinal side effects, hot flashes, thromboembolic events, and infections vary among drugs.
Few studies have directly compared drugs used to treat osteoporosis. Data in men are very sparse. Costs were not assessed.
Good-quality evidence supports that several medications for bone density in osteoporotic range and/or preexisting hip or vertebral fracture reduce fracture risk. Side effects vary among drugs, and the comparative effectiveness of the drugs is unclear.
Agency for Healthcare Research and Quality and RAND Corporation.
Crandall CJ, Newberry SJ, Diamant A, et al. Comparative Effectiveness of Pharmacologic Treatments to Prevent Fractures: An Updated Systematic Review. Ann Intern Med. 2014;161:711–723. doi: https://doi.org/10.7326/M14-0317
Download citation file:
Published: Ann Intern Med. 2014;161(10):711-723.
Endocrine and Metabolism, Healthcare Delivery and Policy, Metabolic Bone Disorders, Prevention/Screening.
Results provided by:
Copyright © 2020 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
Conditions of Use