Table 22: Meta-Analysis of Effect of Osteoporotic Drug Treatment on Risk of Fracture and Bone Mineral Density Compared With Placebo in Women with Postmenopausal Osteoporosis*.
| Drug | Vertebral Fracture RR (95% CI) | Nonvertebral Fracture RR (95% CI) | Weighted mean difference in BMD in Lumbar Spine (95% CI) |
Follow-up period for BMD |
|---|---|---|---|---|
| Etidronate (107) | 0.63(0.44–0.92) P =.02 |
0.99(0.69–1.42) P =97 |
4.06(3.12–5.00) † Combined hip 2.35 (3.94, 7.44) † |
1–3 yrs |
| Alendronate vs Placebo (108) | (≥ 5mg) 0.52 (CI, 0.43, 0.65) P =<.01 |
(≥ 10 mg) 0.51 (95% CI, 0.38, 0.69) P<.01 |
Spine 7.48 (6.12–8.85) † Combined hip 5.6 (4.8–6.39) † |
(2–3 yrs) (3–4 yrs) |
| Risedronate(109) | 0.64(0.54, 0.77) P =.01 |
0.73 (0.61, 0.87) P< .01 |
Lumbar spine 4.54 (4.12,.97) † Combined hip 2.73(2.32, 3.15) † |
1.5–3 yrs |
| Raloxifene(110) | 0.60(0.50,0.70) P =.01 |
0.91 (0.79,1.06) P =.24 |
Lumbar spine 2.51 (2.21,2.82) † Combined hip 2.11(1.68, 2.53) † |
2–3 yrs |
| HRT (111) | 0.66(0.41, 1.07 P =.12 |
0.87(0.71,1.08) P =.10 |
Lumbar spine 6.76 (5.63, 7.89) † Combined hip 4.12 (3.45, 4.8) † |
2 yrs |
| Calcitonin (112) | 0.79(0.62, 1.00) P =.05 |
0.80(0.59, 1.09) P =.16 |
Lumbar spine 3.74 (2.04, 5.43) ‡ Combined hip 3.8 (–0.32, 7.91) |
1–5 yrs |
| Calcium (113) | 0.77(0.54, 1.09) P =.14 |
0.86(0.43,1.72) P =.66 |
Lumbar spine 1.66 (0.92, 2.38) † Combined hip 1.64 (0.70, 2.57) † |
2 yrs |
| Vitamin D (114) | 0.63 (0.45, 0.88) P< .01 |
0.77(0.57, 1.04) P =.09 |
Lumbar spine 0.41(–1.40, 2.22) § Combined hip 1.00 (0.22, 1.78) † |
2–5 yrs |
| Parathyroid hormone (115) | 0.31 – 0.35 in postmenopausal women with priorfracture. | 0.3, P = .042 Effect on hip fracture has not been assessed. |
20 or 40 ug/day ⇑ BMD @ lumbar spine & proximal femur in postmenopausal women with prior vertebral fractures. ⇑ in lumbar spine BMD & ⇓ fracture risk greater than alendronate | 11 months – 2 yrs |
*
CI refers to confidence interval; mg, milligram; RR, relative risk; Yrs, years.
†
P<.01
‡
P = .07
§
P = .66
Source: Adapted from Cranney A, Guyatt G, Griffith L, Wells G, Tugwell P, Rosen C et al. Meta-analyses of therapies for postmenopausal osteoporosis. IX: Summary of meta-analyses of therapies for postmenopausal osteoporosis. Endocrine Reviews 23(4):570-8, 2002