title: Gastrointestinal and renal side effects of bisphosphonates: differentiating between no proof of difference and proof of no difference.
abstract: BACKGROUND
  This study was aimed at comparing the safety of bisphosphonates in women with osteoporosis by application of equivalence testing.
  
  
  METHODS
  Gastrointestinal and renal side effects were evaluated based on information published in randomized controlled trials.
  
  
  RESULTS
  The data on gastrointestinal side effects (47 trials) indicated that alendronate, risedronate etidronate, and zolendronate have similar rates of the adverse effects; application of Bayesian network meta-analysis showed that equivalence was demonstrated according to margins around ±10%. The data on renal safety were more sparse and suffered from the use of different outcome measures; hence, a single trial could be evaluated. This trial showed a similar effect of alendronate and risedronate on renal function at 12 months; equivalence was based on differences between the two agents in renal function with margins of less than ±10.4 ml/min.
  
  
  CONCLUSIONS
  Our study provided quantitative information to determine to what extent bisphosphonates can be considered equivalent in terms of gastrointestinal and renal side effects.
authors.affiliation: HTA unit, Area Vasta Centro Toscana, Regional Health System, Via San Salvi 12, 50100, Florence, Italy.
authors.forename: V
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: D
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: S
authors.initials: S
authors.lastname: Trippoli
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: A
authors.initials: A
authors.lastname: Messori
mesh_terms: D019386:Alendronate / Q000009:adverse effects; D050071:Bone Density Conservation Agents / Q000009:adverse effects*; D004164:Diphosphonates / Q000009:adverse effects*; D012968:Etidronic Acid / Q000009:adverse effects; D005260:Female; D005767:Gastrointestinal Diseases / Q000139:chemically induced* / Q000453:epidemiology; D006801:Humans; D007674:Kidney Diseases / Q000139:chemically induced* / Q000453:epidemiology; D010024:Osteoporosis / Q000188:drug therapy / Q000453:epidemiology; D015663:Osteoporosis, Postmenopausal / Q000188:drug therapy / Q000453:epidemiology; D016032:Randomized Controlled Trials as Topic
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D012968:Etidronic Acid; D019386:Alendronate
keywords: Bisphosphonates; Equivalence; Osteoporosis; Safety