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Review Article | Open Access

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

Qin Hu1,2, Xun Pan2, Yaxian Liang2, Hongdan Xu2, Jinning Gu2, Wenting 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
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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 lossbisphosphonatesfracturebone mineral densitynano-drug delivery system

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Nano TransMed
Volume 1 Issue 1,
March 2022
Article number: 9130003
DOI: 10.26599/NTM.2022.9130003
Cite this article:
Hu Q, Pan X, Liang Y, et al. Comparative efficacy and safety of bisphosphonate therapy for bone loss in individuals after middle age: A systematic review and network meta-analysis. Nano TransMed, 2022, 1(1): 9130003. https://doi.org/10.26599/NTM.2022.9130003
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Summary of the study design and patient characteristics of the included studies

Included studiesDesignCountryPatients (N)SexFollow-up time (month)Treatment (n)Mean age (year)Age range (year)LS BMD (g/cm2)
[15]RCTItaly211Female12Alendronate (140) vs. Placebo (71)5948–760.74
[16]RCTUnited States359Female24Alendronate (268) vs. Placebo (91)7160–850.72
[17]RCTUnited States, Denmark1, 358Female24Alendronate (168) vs. Placebo (85)5345–590.94
[18]RCTChina78Female12Alendronate (41) vs. Placebo (37)7460–790.63
[19]RCTUnited States186Female36Alendronate (71) vs. Placebo (72)7265–900.89
[20]RCTEurope, Brazil549Female12Risedronate (222) vs. Alendronate (219) vs. Placebo (108)6960–900.72
[21]RCTAustralia383Female24Risedronate (257) vs. Placebo (126)5351–601.08
[22]RCTKorea63Female3Alendronate (22) vs. Placebo (23)5650–60T < −2
[23]RCTUnited States124Female12Ibandronate (77) vs. Placebo (83)5345–600.91
[24]RCTJapan1, 134Female, male36Ibandronate (758) vs. Risedronate (376)73≥ 60−2.71 < T < −2.59
[25]RCTUnited States181Female24Zoledronate (89) vs. Placebo (92)85≥ 650.95
[26]RCTJapan661Female, male24Zoledronate (330) vs. Placebo (331)7465–890.66
[27]RCTNew Zealand2, 000Female36Zoledronate (1000) vs. Placebo (1000)71≥ 65−2.5 < T < −1
[28]RCTChina482Female, male24Zoledronate (353) vs. Placebo (129)7460–95T < −1