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PURPOSE

The purpose of this study was to estimate the benefits and drawbacks of bisphosphonates in the treatment of osteoporosis and osteopenia in middle-aged and elderly individuals.

METHODS

We searched Ovid MEDLINE, Embase, the Web of Science, and Cochrane library databases for randomized clinical trials (RCTs) evaluating the effects of bisphosphonates and performed a network meta-analysis to summarize the direct and indirect evidence on the efficacy and safety of bisphosphonate therapy in middle-aged and elderly individuals with osteoporosis or osteopenia.

RESULTS

A total of 14 RCTs (7, 769 patients with osteoporosis or osteopenia; median age, 67 years; median follow-up, 27 months) were included in this network meta-analysis. Of these, 8, 10, 9, and 6 RCTs provided outcomes on bone mineral density changes, clinical fracture rates, vertebral fracture rates, and nonvertebral fracture rates, respectively. Regarding the primary efficacy outcome, there was a 97% probability for alendronate to be the most effective treatment approach for increasing bone mineral density and an 84% probability for zoledronate to be the most effective treatment approach for clinical fractures. Regarding vertebral fractures and safety outcomes, zoledronate showed an odds ratio (OR) of 0.45 (95% confidence intervals [CI], 0.30–0.69) relative to placebo. For nonvertebral fractures, the OR of zoledronate relative to placebo was 0.51 (95% CI 0.29–0.90).

CONCLUSIONS

This study revealed that alendronate was effective in increasing bone mineral density in middle-aged individuals and that zoledronate was a safe treatment option for osteoporosis and osteopenia, conferring a low incidence of fracture. However, further clinical studies are needed to confirm these results.


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Comparative efficacy and safety of bisphosphonate therapy for bone loss in individuals after middle age: A systematic review and network meta-analysis

Show Author's information Qin Hu1,2Xun Pan2Yaxian Liang2Hongdan Xu2Jinning Gu2Wenting She3( )Huixu Xie2( )
Faculty of Dentistry, Periodontology, The University of Hong Kong, Hong Kong, China
State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
Center of Stomatology, Renmin Hospital of Wuhan University, Wuhan 430061, China

Abstract

PURPOSE

The purpose of this study was to estimate the benefits and drawbacks of bisphosphonates in the treatment of osteoporosis and osteopenia in middle-aged and elderly individuals.

METHODS

We searched Ovid MEDLINE, Embase, the Web of Science, and Cochrane library databases for randomized clinical trials (RCTs) evaluating the effects of bisphosphonates and performed a network meta-analysis to summarize the direct and indirect evidence on the efficacy and safety of bisphosphonate therapy in middle-aged and elderly individuals with osteoporosis or osteopenia.

RESULTS

A total of 14 RCTs (7, 769 patients with osteoporosis or osteopenia; median age, 67 years; median follow-up, 27 months) were included in this network meta-analysis. Of these, 8, 10, 9, and 6 RCTs provided outcomes on bone mineral density changes, clinical fracture rates, vertebral fracture rates, and nonvertebral fracture rates, respectively. Regarding the primary efficacy outcome, there was a 97% probability for alendronate to be the most effective treatment approach for increasing bone mineral density and an 84% probability for zoledronate to be the most effective treatment approach for clinical fractures. Regarding vertebral fractures and safety outcomes, zoledronate showed an odds ratio (OR) of 0.45 (95% confidence intervals [CI], 0.30–0.69) relative to placebo. For nonvertebral fractures, the OR of zoledronate relative to placebo was 0.51 (95% CI 0.29–0.90).

CONCLUSIONS

This study revealed that alendronate was effective in increasing bone mineral density in middle-aged individuals and that zoledronate was a safe treatment option for osteoporosis and osteopenia, conferring a low incidence of fracture. However, further clinical studies are needed to confirm these results.

Keywords:

bone loss, bisphosphonates, fracture, bone mineral density, nano-drug delivery system
Received: 09 January 2021 Revised: 17 February 2022 Accepted: 18 February 2022 Published: 28 February 2022 Issue date: March 2022
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Publication history

Received: 09 January 2021
Revised: 17 February 2022
Accepted: 18 February 2022
Published: 28 February 2022
Issue date: March 2022

Copyright

© The Author(s) 2022. Nano TransMed published by Tsinghua University Press.

Acknowledgements

Acknowledgements

This work was supported by the National Natural Science Foundation of China (No. 51641305) and an open fund of Guangdong Provincial Key Laboratory of Stomatology.

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