Table 1.
Estimates of effects and quality ratings for comparison of drug treatments for osteoporosis to prevent clinical fractures
| Comparison | Direct evidence | Network meta-analysis | |||
|---|---|---|---|---|---|
| Relative risk (95% CI) |
Absolute risk difference* (95% CI) |
Odds ratio (95% CI) |
Certainty of evidence | ||
| Parathyroid hormone receptor agonists v placebo | 0.58 (0.35 to 0.95) | 35 fewer per 1000 (39 fewer to 3 fewer)† | — | Moderate¶ | |
| Selective oestrogen receptor modulators v placebo | 0.41 (0.10 to 1.69) | — | — | Low¶ ** | |
| Romosozumab v placebo | 0.64 (0.47 to 0.89) | 9 fewer per 1000 (13 fewer to 3 fewer)‡ | — | Low¶ ** | |
| Parathyroid hormone receptor agonists v bisphosphonates | 0.61 (0.39 to 0.94) | — | — | Moderate¶ | |
| Denosumab v bisphosphonates | 1.28 (0.91 to 1.81) | — | — | Low¶ ** | |
| Romosozumab v bisphosphonates | 0.82 (0.68 to 0.99) | — | — | Low¶ ** | |
| Romosozumab v parathyroid hormone receptor agonists | 0.88 (0.32 to 2.37) | — | — | Low¶ ** | |
| Bisphosphonates v denosumab | — | — | 0.81 (0.57 to 1.15) | Low¶ ** | |
| Bisphosphonates v placebo | 0.81 (0.72 to 0.91) | 14 fewer per 1000 (21 fewer to 7 fewer)§ | 0.79 (0.70 to 0.89) | Moderate¶ | |
| Bisphosphonates v parathyroid hormone receptor agonists | — | — | 1.49 (1.12 to 2.00) | Moderate¶ | |
| Bisphosphonates v romosozumab | — | — | 1.26 (0.99 to 1.60) | Low¶ ** | |
| Bisphosphonates v selective oestrogen receptor modulators | 0.96 (0.48 to 1.94) | — | 1.40 (0.72 to 2.71) | Low¶ ** | |
| Denosumab v placebo | 3.08 (0.42 to 22.33) | — | 0.98 (0.68 to 1.41) | Low¶ ** | |
| Denosumab v parathyroid hormone receptor agonists | — | — | 1.85 (1.18 to 2.92) | Moderate¶ | |
| Denosumab v romosozumab | — | — | 1.56 (1.02 to 2.39) | Moderate¶ | |
| Denosumab v selective oestrogen receptor modulators | — | — | 1.74 (0.82 to 3.66) | Low¶ ** | |
| Placebo v parathyroid hormone receptor agonists | — | — | 1.90 (1.41 to 2.55) | Moderate¶ | |
| Placebo v romosozumab | — | — | 1.60 (1.24 to 2.05) | Low¶ ** | |
| Placebo v selective oestrogen receptor modulators | — | — | 1.78 (0.91 to 3.47) | Low¶ ** | |
| Parathyroid hormone receptor agonists v romosozumab | — | — | 0.84 (0.59 to 1.21) | Low¶ ** | |
| Parathyroid hormone receptor agonists v selective oestrogen receptor modulators | — | — | 0.94 (0.46 to 1.93) | Low¶ ** | |
| Romosozumab v selective oestrogen receptor modulators | — | — | 1.11 (0.55 to 2.25) | Low¶ ** | |
CI=confidence interval.
*
Absolute measure of intervention effects is difference between baseline risk of outcome (median in control group) and risk of outcome after intervention is applied.