title: Systematic review: comparative effectiveness of treatments to prevent fractures in men and women with low bone density or osteoporosis.
abstract: BACKGROUND
  Although several agents are available to treat osteoporosis, the relative efficacy and toxicity of these agents when used to prevent fractures has not been well described.
  
  
  OBJECTIVE
  To compare the benefits in fracture reduction and the harms from adverse events of various therapies for osteoporosis.
  
  
  METHODS
  MEDLINE (1966 to November 2007) and other selected databases were searched for English-language studies.
  
  
  METHODS
  For the efficacy analysis, investigators selected studies that reported the rate of or risk for fractures. For the adverse event analysis, they selected studies that reported the relationship between an agent and cardiovascular, thromboembolic, or upper gastrointestinal events; malignant conditions; and osteonecrosis.
  
  
  METHODS
  Using a standardized protocol, investigators abstracted data on fractures and adverse events, agents and comparators, study design, and variables of methodological quality.
  
  
  RESULTS
  Good evidence suggests that alendronate, etidronate, ibandronate, risedronate, zoledronic acid, estrogen, parathyroid hormone (1-34), and raloxifene prevent vertebral fractures more than placebo; the evidence for calcitonin was fair. Good evidence suggests that alendronate, risedronate, and estrogen prevent hip fractures more than placebo; the evidence for zoledronic acid was fair. The effects of vitamin D varied with dose, analogue, and study population for both vertebral and hip fractures. Raloxifene, estrogen, and estrogen-progestin increased the risk for thromboembolic events, and etidronate increased the risk for esophageal ulcerations and gastrointestinal perforations, ulcerations, and bleeding.
  
  
  CONCLUSIONS
  Few studies have directly compared different agents or classes of agents used to treat osteoporosis.
  
  
  CONCLUSIONS
  Although good evidence suggests that many agents are effective in preventing osteoporotic fractures, the data are insufficient to determine the relative efficacy or safety of these agents.
authors: Southern California Evidence-based Practice Center, RAND, Santa Monica, CA 90401, USA.
authors: Catherine
authors: C
authors: MacLean
authors: Sydne
authors: S
authors: Newberry
authors: Margaret
authors: M
authors: Maglione
authors: Maureen
authors: M
authors: McMahon
authors: Veena
authors: V
authors: Ranganath
authors: Marika
authors: M
authors: Suttorp
authors: Walter
authors: W
authors: Mojica
authors: Martha
authors: M
authors: Timmer
authors: Alicia
authors: A
authors: Alexander
authors: Melissa
authors: M
authors: McNamara
authors: Sheetal B
authors: SB
authors: Desai
authors: Annie
authors: A
authors: Zhou
authors: Susan
authors: S
authors: Chen
authors: Jason
authors: J
authors: Carter
authors: Carlo
authors: C
authors: Tringale
authors: Di
authors: D
authors: Valentine
authors: Breanne
authors: B
authors: Johnsen
authors: Jennifer
authors: J
authors: Grossman
mesh_terms: D000728:Androgens / Q000009:adverse effects / Q000627:therapeutic use; D015519:Bone Density; D050071:Bone Density Conservation Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002118:Calcium / Q000009:adverse effects / Q000627:therapeutic use; D015914:Estrogen Replacement Therapy / Q000009:adverse effects; D004967:Estrogens / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D050723:Fractures, Bone / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D008297:Male; D010024:Osteoporosis / Q000150:complications*; D012307:Risk Factors; D020845:Selective Estrogen Receptor Modulators / Q000009:adverse effects / Q000627:therapeutic use*; D013739:Testosterone / Q000009:adverse effects / Q000627:therapeutic use; D014807:Vitamin D / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D000728:Androgens; D050071:Bone Density Conservation Agents; D004967:Estrogens; D020845:Selective Estrogen Receptor Modulators; D014807:Vitamin D; D013739:Testosterone; D002118:Calcium