title: Anti-reabsorptive agents in women with osteoporosis: determining statistical equivalence according to evidence-based methods.
abstract: BACKGROUND
  In the present study, we undertook an equivalence analysis on the effectiveness of the main anti-reabsorptive agents indicated for women with osteoporosis.
  
  
  METHODS
  Our methodology was a combination of meta-analysis (both pair-wise meta-analysis and network meta-analysis) and equivalence testing. The end-point was the incidence on new vertebral fractures. The anti-reabsorptive agents examined included alendronate, zoledronate, ibandronate, risedronate, and denosumab.
  
  
  RESULTS
  Our analysis involved nine randomized trials. Ten head-to-head indirect comparisons were examined through network meta-analysis and the respective values of RR were estimated. The 95 % confidence intervals for RR remained within the interval of a relative ±40 % variation for all comparisons that involved alendronate, risedronate, ibandronate, and denosumab. In contrast, the comparisons involving zoledronate satisfied a post hoc margin up to ±67 %.
  
  
  CONCLUSIONS
  Our results confirm that most of these anti-reabsorptive drugs (namely, alendronate, risedronate, ibandronate, and denosumab) are equivalent according to reasonable equivalence margins.
authors.affiliation: HTA Unit, Area Vasta Centro Toscana Regional Health System, Via San Salvi 12, 50100, Florence, Italy. andrea.messori.it@gmail.com.
authors.forename: Andrea
authors.initials: A
authors.lastname: Messori
authors.affiliation: HTA Unit, Area Vasta Centro Toscana Regional Health System, Via San Salvi 12, 50100, Florence, Italy.
authors.forename: Valeria
authors.initials: V
authors.lastname: Fadda
authors.affiliation: HTA Unit, Area Vasta Centro Toscana Regional Health System, Via San Salvi 12, 50100, Florence, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Maratea
authors.affiliation: HTA Unit, Area Vasta Centro Toscana Regional Health System, Via San Salvi 12, 50100, Florence, Italy.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Trippoli
authors.affiliation: Department of Pharmaceutical Logistics, ESTAV Toscana Centro, Regional Health Service, 50100, Florence, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Marinai
mesh_terms: D019386:Alendronate / Q000493:pharmacokinetics / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000493:pharmacokinetics / Q000627:therapeutic use; D050071:Bone Density Conservation Agents / Q000493:pharmacokinetics / Q000627:therapeutic use*; D000069448:Denosumab; D004164:Diphosphonates / Q000493:pharmacokinetics / Q000627:therapeutic use; D012968:Etidronic Acid / Q000031:analogs & derivatives / Q000493:pharmacokinetics / Q000627:therapeutic use; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D000077557:Ibandronic Acid; D015994:Incidence; D015663:Osteoporosis, Postmenopausal / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology; D058866:Osteoporotic Fractures / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic; D000068296:Risedronic Acid; D016103:Spinal Fractures / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D013810:Therapeutic Equivalency
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D000069448:Denosumab; D000068296:Risedronic Acid; D012968:Etidronic Acid; D000077557:Ibandronic Acid; D019386:Alendronate