Putting evidence-based medicine into clinical practice: comparing anti-resorptive agents for the treatment of osteoporosis.
OBJECTIVE
To compare the effectiveness of antiresorptive agents in reducing the risk of vertebral and non-vertebral fractures using data from published meta-analyses and the technique of adjusted indirect comparisons.


METHODS
Pairs of agents were compared by adjusted indirect comparison of 0.56 [0.40, 0.78], respectively) in reducing the their effects relative to a common comparator (placebo) using meta-analyses published by The Osteoporosis Methodology Group and The Osteoporosis Research Advisory Group.


RESULTS
Adjusted indirect comparisons identified only one pair of agents that had significantly different effects on vertebral fracture incidence: alendronate was 34% more effective than calcitonin (Relative Risk: 0.66, 95% Confidence Interval: 0.48-0.90). Alendronate was significantly more effective than risedronate, calcitonin, estrogen, etidronate, and raloxifene (Relative Risks: 0.70 [0.49, 0.99], 0.64 [0.42, 0.98], 0.59 [0.41, 0.84], 0.52 [0.32, 0.82], and incidence of non-vertebral fractures. No other significant pairwise differences were observed.


CONCLUSIONS
The results suggest that there are differences in anti-fracture efficacy among antiresorptive agents, particularly for non-vertebral fractures. Direct head-to-head comparisons would be needed to confirm these findings but are unlikely to be conducted.
Wehren
Lois E
LE
University of Maryland School of Medicine, Baltimore, MD, USA. lois_wehren@msn.com
Hosking
David
D
Hochberg
Marc C
MC
D019386:Alendronate / Q000627:therapeutic use; D001862:Bone Resorption / Q000517:prevention & control; D019317:Evidence-Based Medicine; D005260:Female; D005598:Fractures, Spontaneous / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D015201:Meta-Analysis as Topic; D015663:Osteoporosis, Postmenopausal / Q000188:drug therapy*; D016103:Spinal Fractures / Q000209:etiology / Q000517:prevention & control
D019386:Alendronate