Abstract

Background

Bone loss with aging and menopause increases the risk of fragile vertebral fracture, osteoporotic vertebral compression fracture (OVCF). The fracture causes severe pain, impedes respiratory function, lower the quality of life, and increases the risk of new fractures and deaths. Various medications have been prescribed to prevent a secondary fracture, but few study summarized their effects. Therefore, we investigated their effects on preventing subsequent OVCF via meta-analyses of randomized controlled trials.

Methods

Electronic databases, including MEDLINE, EMBASE, CENTRAL, and Web of Science were searched for published randomized controlled trials from June 2015 to June 2019. The trials that recruited participants with at least one OVCF were included. We assessed the risk of bias of every study, estimated relative risk ratio of secondary OVCF, non-vertebral fracture, gastrointestinal complaints and discontinuation due to adverse events. Finally, we evaluated the quality of evidence.

Results

Forty-one articles were included. Moderate to high quality evidence proved the effectiveness of zoledronate (Relative Risk, RR: 0.34; 95% CI, 0.17–0.69, p = 0.003), alendronate (RR: 0.54; 95% CI: 0.43–0.68; p < 0.0001), risedronate (RR: 0.61; 95% CI: 0.51–0.73; p < 0.0001), etidronate (RR, 0.50; 95% CI, 0.29–0.87, p < 0.01), ibandronate (RR: 0.52; 95% CI: 0.38–0.71; p < 0.0001), parathyroid hormone (RR: 0.31; 95% CI: 0.23–0.41; p < 0.0001), denosumab (RR, 0.41; 95% CI, 0.29–0.57; p < 0.0001) and selective estrogen receptor modulators (Raloxifene, RR: 0.58; 95% CI: 0.44–0.76; p < 0.0001; Bazedoxifene, RR: 0.66; 95% CI: 0.53–0.82; p = 0.0002) in preventing secondary fractures. Moderate quality evidence proved romosozumab had better effect than alendronate (Romosozumab vs. alendronate, RR: 0.64; 95% CI: 0.49–0.84; p = 0.001) and high quality evidence proved that teriparatide had better effect than risedronate (risedronate vs. teriparatide, RR: 1.98; 95% CI: 1.44–2.70; p < 0.0001).

Conclusion

Zoledronate, alendronate, risedronate, etidronate, ibandronate, parathyroid hormone, denosumab and selective estrogen receptor modulators had significant secondary prevention effects on OVCF. Moderate quality evidence proved romosozumab had better effect than alendronate. High quality evidence proved PTH had better effect than risedronate, but with higher risk of adverse events.

Details

Title
Effect of medications on prevention of secondary osteoporotic vertebral compression fracture, non-vertebral fracture, and discontinuation due to adverse events: a meta-analysis of randomized controlled trials
Author
Yuan-Zhe, Jin; Lee, Jae Hyup; Xu, Bin; Cho, Minjoon
Section
Research article
Publication year
2019
Publication date
2019
Publisher
BioMed Central
e-ISSN
14712474
Source type
Scholarly Journal
Language of publication
English
ProQuest document ID
2292922597
Copyright
© 2019. This work is licensed under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.