Evidence-based medicine and osteoporosis: a comparison of fracture risk reduction data from osteoporosis randomised clinical trials.
The goal of osteoporosis therapy is to prevent fractures, and many therapies are available for this disease. Regarding proven fracture benefit, however, the quality of the randomised clinical trial evidence varies substantially among therapies. The purpose of this paper is, therefore, to review the published osteoporosis randomised clinical trial literature and to assess the quality of the evidence. Although more than 35 randomised trials for different therapies were reviewed, only alendronate and vitamin D plus calcium have clearly demonstrated a fracture benefit, with alendronate providing the greatest relative risk reduction. Quality clinical trial fracture data for calcitonin, etidronate, fluoride, hormone replacement therapy, parathyroid hormone, calcitriol (and other vitamin D preparations), vitamin D and calcium monotherapy, and selective oestrogen receptor modulators are either lacking or inconclusive or published only as abstracts.
Meunier
P J
PJ
Department of Rheumatology and Bone Diseases, Edouard Herriot Hospital, Lyon, France.
D019386:Alendronate / Q000627:therapeutic use; D002116:Calcitonin / Q000627:therapeutic use; D002117:Calcitriol / Q000627:therapeutic use; D002118:Calcium / Q000627:therapeutic use; D002124:Calcium Fluoride / Q000627:therapeutic use; D019317:Evidence-Based Medicine; D050723:Fractures, Bone / Q000209:etiology / Q000517:prevention & control*; D020249:Hormone Replacement Therapy; D006801:Humans; D010024:Osteoporosis / Q000150:complications / Q000188:drug therapy*; D010281:Parathyroid Hormone / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D011960:Receptors, Estrogen; D014807:Vitamin D / Q000627:therapeutic use
D010281:Parathyroid Hormone; D011960:Receptors, Estrogen; D014807:Vitamin D; D002116:Calcitonin; D002117:Calcitriol; D002124:Calcium Fluoride; D002118:Calcium; D019386:Alendronate