Catherine MacLean, MD, PhD; Sydne Newberry, PhD; Margaret Maglione, MPP; Maureen McMahon, MD; Veena Ranganath, MD; Marika Suttorp, MS; Walter Mojica, MD; Martha Timmer, MS; Alicia Alexander, MD; Melissa McNamara, MD; Sheetal B. Desai, MD, MS; Annie Zhou, MS; Susan Chen, BA; Jason Carter, BA; Carlo Tringale, BA; Di Valentine, JD; Breanne Johnsen, BA; Jennifer Grossman, MD
Disclaimer: Dr. MacLean is employed by WellPoint. This paper and its content reflect the views of Dr. MacLean and have not been reviewed or endorsed by WellPoint.
Acknowledgment: The authors acknowledge the guidance provided by the Technical but have Expert Panel members: Marc C. Hochberg, MD, MPH; Lee J. Melton III, MD, MPH; Paul D. Miller, MD; Marcel E. Salive, MD, MPH; and Katherine Sherif, MD. They also acknowledge the careful work of the reviewers, and the invaluable assistance of Julie Newell, Jianglai Zhang, Scott Hiromoto, Yuyan (Sabrina) Shi, and Zhen (Frank) Wang.
Grant Support: Prepared under contract with the Agency for Healthcare Research and Quality (contract no. 290-02-003).
Potential Financial Conflicts of Interest:Stock ownership or options (other than mutual funds): J. Grossman (Johnson & Johnson).
Requests for Single Reprints: Margaret Maglione, MPP, RAND Corporation, 1776 Main Street, Santa Monica, CA 90401; e-mail, firstname.lastname@example.org.
Current Author Addresses: Dr. MacLean: WellPoint, 4553 LaTienda Drive, M/S CAT102-C003, Thousand Oaks, CA 91362.
Dr. Newberry, Ms. Maglione, Ms. Suttorp, Ms. Timmer, Ms. Zhou, Ms. Chen, Mr. Carter, Mr. Tringale, Ms. Valentine, and Ms. Johnsen: RAND Corporation, 1776 Main Street, Santa Monica, CA 90407-2138.
Drs. McMahon, Ranganath, Desai, and Grossman: University of California, Los Angeles, 1000 Veteran Avenue 32-59, Los Angeles, CA 90095.
Dr. Mojica: Kaiser Permanente, 393 Walnut Center, Pasadena, CA 91188.
Dr. Alexander: c/o Margaret Maglione, MPP, RAND Corporation, 1776 Main Street, Santa Monica, CA 90401.
Dr. McNamara: Arthritis and Rheumatology Center, 5601 Norris Canyon Road, Suite 340, San Ramon, CA 94583.
Although several agents are available to treat osteoporosis, the relative efficacy and toxicity of these agents when used to prevent fractures has not been well described.
To compare the benefits in fracture reduction and the harms from adverse events of various therapies for osteoporosis.
MEDLINE (1966 to November 2007) and other selected databases were searched for English-language studies.
For the efficacy analysis, investigators selected studies that reported the rate of or risk for fractures. For the adverse event analysis, they selected studies that reported the relationship between an agent and cardiovascular, thromboembolic, or upper gastrointestinal events; malignant conditions; and osteonecrosis.
Using a standardized protocol, investigators abstracted data on fractures and adverse events, agents and comparators, study design, and variables of methodological quality.
Good evidence suggests that alendronate, etidronate, ibandronate, risedronate, zoledronic acid, estrogen, parathyroid hormone (1-34), and raloxifene prevent vertebral fractures more than placebo; the evidence for calcitonin was fair. Good evidence suggests that alendronate, risedronate, and estrogen prevent hip fractures more than placebo; the evidence for zoledronic acid was fair. The effects of vitamin D varied with dose, analogue, and study population for both vertebral and hip fractures. Raloxifene, estrogen, and estrogen–progestin increased the risk for thromboembolic events, and etidronate increased the risk for esophageal ulcerations and gastrointestinal perforations, ulcerations, and bleeding.
Few studies have directly compared different agents or classes of agents used to treat osteoporosis.
Although good evidence suggests that many agents are effective in preventing osteoporotic fractures, the data are insufficient to determine the relative efficacy or safety of these agents.
MacLean C, Newberry S, Maglione M, et al. Systematic Review: Comparative Effectiveness of Treatments to Prevent Fractures in Men and Women with Low Bone Density or Osteoporosis. Ann Intern Med. 2008;148:197–213. doi: 10.7326/0003-4819-148-3-200802050-00198
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Published: Ann Intern Med. 2008;148(3):197-213.
Emergency Medicine, Endocrine and Metabolism, Metabolic Bone Disorders.
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