Osteoporosis treatment in postmenopausal women with pre-existing fracture.
Osteoporotic patients with existing fractures are at substantially higher risk of subsequent fractures than those free of fractures. Given the lack of head-to-head comparison trials, indirect comparison of various antiosteoporosis treatments may be an alternative way to develop a preliminary idea. The objective of this study is to conduct a systematic review of antiosteoporosis treatment clinical trials that have investigated on patients with existing fractures. All the results of randomized placebo-controlled trials of the available antiosteoporosis treatments, including bisphosphonates, selective estrogen receptor modulators, calcitonin, strontium ranelate, and agents derived from parathyroid hormone, on patients with existing fractures were summarized. All the antiosteoporotic agents had significant efficacy in increasing lumbar spine bone mineral density and reduction in the occurrence of any new vertebral fractures. All interventions provided gains in quality-adjusted life-years compared with patients without treatment. The results from an indirect comparison must be interpreted with caution due to heterogeneous study design, discrepancies of disease severity at baseline, and differences in analytical methodologies. The devastating complications subsequent to osteoporotic fractures create medical and financial burdens; therefore, treatment of patients with osteoporotic fractures should be positioned in the top priority in the utilization of medical resources.
Department of Obstetrics and Gynecology and Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.
Ming-Huei
MH
Cheng
Jung-Fu
JF
Chen
Jong-Ling
JL
Fuh
Wen-Ling
WL
Lee
Peng-Hui
PH
Wang
D015519:Bone Density / Q000187:drug effects; D050071:Bone Density Conservation Agents / Q000009:adverse effects / Q000191:economics / Q000494:pharmacology* / Q000627:therapeutic use*; D002116:Calcitonin / Q000494:pharmacology / Q000627:therapeutic use; D004164:Diphosphonates / Q000494:pharmacology / Q000627:therapeutic use; D005260:Female; D050723:Fractures, Bone / Q000517:prevention & control*; D006801:Humans; D009942:Organometallic Compounds / Q000494:pharmacology / Q000627:therapeutic use; D015663:Osteoporosis, Postmenopausal / Q000188:drug therapy*; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D020845:Selective Estrogen Receptor Modulators / Q000494:pharmacology / Q000627:therapeutic use; D019379:Teriparatide / Q000494:pharmacology / Q000627:therapeutic use; D013876:Thiophenes / Q000494:pharmacology / Q000627:therapeutic use
D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D009942:Organometallic Compounds; D020845:Selective Estrogen Receptor Modulators; D013876:Thiophenes; C081587:strontium ranelate; D019379:Teriparatide; D002116:Calcitonin