Effectiveness of anti-osteoporotic drugs to prevent secondary fragility fractures: systematic review and meta-analysis

• Published in: Osteoporosis international Vol. 28; no. 12; pp. 3289 - 3300
• Main Authors: Saito, T., Sterbenz, J. M., Malay, S., Zhong, L., MacEachern, M. P., Chung, K. C.
• Format: Journal Article
• Language: English
• Published: London Springer London 01.12.2017; Springer Nature B.V
• Subjects: Bisphosphonates; Bone Density Conservation Agents - therapeutic use; Calcitonin; Clinical trials; Diphosphonates - therapeutic use; Drugs; Endocrinology; Fractures; Humans; Medicine; Medicine & Public Health; Meta-analysis; Orthopedics; Osteoporosis; Osteoporosis - complications; Osteoporosis - drug therapy; Osteoporotic Fractures - prevention & control; Parathyroid; Parathyroid hormone; Review; Rheumatology; Secondary Prevention - methods; Selective estrogen receptor modulators; Spinal Fractures - etiology; Spinal Fractures - prevention & control; Systematic review; Vertebrae; Osteoporosis; Parathyroid hormone; Secondary fractures; Drug therapy; Selective estrogen receptor modulators; Bisphosphonates; Fragility fracture
• ISSN: 0937-941X; 1433-2965
• DOI: 10.1007/s00198-017-4175-0

Patients with osteoporotic fractures have an increased risk for secondary fractures. However, a rigorous study that assesses the effectiveness of individual osteoporotic drugs in preventing subsequent fractures is lacking. The purpose of this review was to analyze the effectiveness of anti-osteoporotic drugs in preventing secondary fractures. We searched for randomized controlled trials that showed the incidence of secondary fractures while using anti-osteoporotic drugs (bisphosphonates, selective estrogen receptor modulators, parathyroid hormone (PTH), or calcitonin) in MEDLINE, Embase.com , and Cochrane Central Register databases. We estimated risk ratios (RR) and numbers needed to treat (NNT) to prevent secondary fractures. Twenty-six studies met our eligibility criteria. There was a significant reduction in RR (0.38–0.77) after the use of anti-osteoporotic drugs for secondary vertebral fractures. Bisphosphonates and PTH significantly reduced the risk of a secondary non-vertebral fracture (RR 0.59 and 0.64). PTH needed the fewest number of patients to be treated to prevent a secondary vertebral fracture (NNT: 56). Our study demonstrated the effectiveness of anti-osteoporotic agents included in our systematic review in preventing secondary vertebral fractures. Bisphosphonates and PTH were most effective in preventing non-vertebral fractures. We suggest that clinicians should prescribe these drugs to prevent secondary vertebral/non-vertebral fractures.