title: Comparative effectiveness of pharmacologic treatments to prevent fractures: an updated systematic review.
abstract: BACKGROUND
  Osteoporosis is a major contributor to the propensity to fracture among older adults, and various pharmaceuticals are available to treat it.
  
  
  OBJECTIVE
  To update a review about the benefits and harms of pharmacologic treatments used to prevent fractures in adults at risk.
  
  
  METHODS
  Multiple computerized databases were searched between 2 January 2005 and 4 March 2014 for English-language studies.
  
  
  METHODS
  Trials, observational studies, and systematic reviews.
  
  
  METHODS
  Duplicate extraction and assessment of data about study characteristics, outcomes, and quality.
  
  
  RESULTS
  From more than 52 000 titles screened, 315 articles were included in this update. There is high-strength evidence that bisphosphonates, denosumab, and teriparatide reduce fractures compared with placebo, with relative risk reductions from 0.40 to 0.60 for vertebral fractures and 0.60 to 0.80 for nonvertebral fractures. Raloxifene has been shown in placebo-controlled trials to reduce only vertebral fractures. Since 2007, there is a newly recognized adverse event of bisphosphonate use: atypical subtrochanteric femur fracture. Gastrointestinal side effects, hot flashes, thromboembolic events, and infections vary among drugs.
  
  
  CONCLUSIONS
  Few studies have directly compared drugs used to treat osteoporosis. Data in men are very sparse. Costs were not assessed.
  
  
  CONCLUSIONS
  Good-quality evidence supports that several medications for bone density in osteoporotic range and/or preexisting hip or vertebral fracture reduce fracture risk. Side effects vary among drugs, and the comparative effectiveness of the drugs is unclear.
  
  
  BACKGROUND
  Agency for Healthcare Research and Quality and RAND Corporation.
authors.forename: Carolyn J
authors.initials: CJ
authors.lastname: Crandall
authors.forename: Sydne J
authors.initials: SJ
authors.lastname: Newberry
authors.forename: Allison
authors.initials: A
authors.lastname: Diamant
authors.forename: Yee-Wei
authors.initials: YW
authors.lastname: Lim
authors.forename: Walid F
authors.initials: WF
authors.lastname: Gellad
authors.forename: Marika J
authors.initials: MJ
authors.lastname: Booth
authors.forename: Aneesa
authors.initials: A
authors.lastname: Motala
authors.forename: Paul G
authors.initials: PG
authors.lastname: Shekelle
mesh_terms: D015502:Absorptiometry, Photon; D000328:Adult; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000209:etiology; D015519:Bone Density; D050071:Bone Density Conservation Agents / Q000009:adverse effects / Q000627:therapeutic use*; D057186:Comparative Effectiveness Research; D000069448:Denosumab; D005260:Female; D050723:Fractures, Bone / Q000517:prevention & control*; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000139:chemically induced; D010024:Osteoporosis / Q000188:drug therapy*; D058866:Osteoporotic Fractures / Q000517:prevention & control*; D019379:Teriparatide / Q000627:therapeutic use
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D050071:Bone Density Conservation Agents; D019379:Teriparatide; D000069448:Denosumab