title: Efficacy of bisphosphonates against osteoporosis in adult men: a meta-analysis of randomized controlled trials.
abstract: This meta-analysis of published randomized controlled trials (RCTs) aimed to analyze the efficacy of administration of bisphosphonates in men with osteoporosis. Compared with placebo, bisphosphonates could reduce the risk of vertebral and non-vertebral fractures, reduce bone-specific alkaline phosphatase (BSAP) and C-terminal telopeptide of type I collagen (CTX), and increase bone mineral density (BMD).
  
  
  BACKGROUND
  Bisphosphonates are well-investigated antiresorptive medications, approved as first-line drugs for osteoporosis in postmenopausal women. However, there is a paucity of high-quality evidence regarding the efficacy of bisphosphonates administered for osteoporosis in adult men. The aim of this meta-analysis was to analyse the efficacy of administration of bisphosphonates in men based on published RCTs.
  
  
  METHODS
  PubMed, Embase, MEDLINE, and the Cochrane library were searched, and mean differences were calculated to evaluate the efficacy of bisphosphonates on reducing the risk of vertebral and non-vertebral fracture, reducing bone-turnover biomarkers, and increasing BMD.
  
  
  RESULTS
  Nine RCTs were included and the total number of participants was 2464. Compared with placebo, the efficacy of bisphosphonates on vertebral and non-vertebral fracture risk reduction was confirmed [for vertebral fracture, RR (95 % CI) 0.36 (0.24, 0.56), P < 0.01; for non-vertebral fracture, RR (95 % CI) 0.52 (0.32, 0.84), P < 0.01)] and heterogeneity was insignificant. The efficacy of bisphosphonates on reducing BSAP [MD (95 % CI) -24.41 (-26.19, -22.62), P < 0.01) and CTX [MD (95 % CI) -34.51 (-41.03, -27.98), P < 0.01)] was significant. A sensitivity analysis was applied to explain the origination of heterogeneity in analysis of decreasing of BSAP. BMD was increased in the bisphosphonates group compared with the control group at lumbar spine, femoral neck, and total hip (P < 0.01), and the heterogeneity of all comparisons was significant.
  
  
  CONCLUSIONS
  Compared with placebo, bisphosphonates could decrease the risk of vertebral and non-vertebral fractures, reduce BSAP and CTX, and increase BMD in men with osteoporosis.
authors.affiliation: Department of Endocrinology and Metabolism, Sir Run Run Shaw Hospital Affiliated with School of Medicine, Zhejiang University, No. 3 Qingchun East Road, Hangzhou, 310000, People's Republic of China.
authors.forename: L
authors.initials: L
authors.lastname: Chen
authors.forename: G
authors.initials: G
authors.lastname: Wang
authors.forename: F
authors.initials: F
authors.lastname: Zheng
authors.forename: H
authors.initials: H
authors.lastname: Zhao
authors.forename: H
authors.initials: H
authors.lastname: Li
mesh_terms: D015415:Biomarkers / Q000378:metabolism; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D016723:Bone Remodeling / Q000187:drug effects; D004164:Diphosphonates / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D010024:Osteoporosis / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D058866:Osteoporotic Fractures / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D040242:Risk Reduction Behavior; D016103:Spinal Fractures / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control
chemical_list: D015415:Biomarkers; D050071:Bone Density Conservation Agents; D004164:Diphosphonates