title: Comparison of Bone Mineral Density in Lumbar Spine and Fracture Rate among Eight Drugs in Treatments of Osteoporosis in Men: A Network Meta-Analysis.
abstract: BACKGROUND
  The preferred treatment for osteoporosis in men is debated, and pairwise meta-analysis cannot obtain hierarchies of these treatments.
  
  
  OBJECTIVE
  The objective of this study was to integrate the evidence and provide hierarchies of eight drugs based on their effect on the bone mineral density in the lumbar spine (BMD in LS) and the fracture rate.
  
  
  METHODS
  Eligible studies were identified by searching Amed, British Nursing Index, EMBASE, PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL), Google Scholar, SIGLE, the National Technical Information Service, the National Research Register (UK), and the Current Controlled Trials databases.
  
  
  METHODS
  RCTs or quasi-RCTs reporting at least two drugs (two active drugs or one active drug and a placebo) used to treat osteoporosis in men were selected by two authors.
  
  
  METHODS
  Two authors independently extracted the data.
  
  
  RESULTS
  Thirteen studies involving 3647 patients were included. Compared with placebo therapy, zoledronate (SMDs 13.48, 95% credible intervals 11.88-15.08) yielded the most significant effect on increasing the BMD in LS, followed by alendronate (11.04, 9.68-12.41), teriparatide (20mcg) + risedronate (10.98, 8.55-13.48), risedronate (10.33, 8.68-12.01), teriparatide (20mcg) (9.33, 6.87-11.76), strontium ranelate (8.88, 7.51-10.24), ibandronate (5.49, 3.82-7.16), parathyroid hormone (1-84) (4.89, 3.12-6.62) and alfacalcidol (3.42, 1.7-5.2). Placebo therapy had a significantly higher fracture rate in contrast to risedronate (OR 2.51, 95% CrI 1.23-4.24) or zoledronate (2.92, 1.29-5.62) or teriparatide (20mcg) (4.04, 1.36-8.49) or teriparatide (40mcg) (3.5, 1.14-8.34). Zoledronate ranked first for increasing the BMD in LS, and teriparatide (20mg) was ranked first for decreasing the fracture rate.
  
  
  CONCLUSIONS
  Zoledronate might be the best choice to increase the BMD in LS and teriparatide (20mg) might lead to the lowest fracture rate.
authors.affiliation: Department of Orthopaedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, People's Republic of China.
authors.forename: Ling-Xiao
authors.initials: LX
authors.lastname: Chen
authors.affiliation: Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
authors.forename: Zhi-Rui
authors.initials: ZR
authors.lastname: Zhou
authors.affiliation: Department of Orthopaedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, People's Republic of China.
authors.forename: Yu-Lin
authors.initials: YL
authors.lastname: Li
authors.affiliation: Department of Orthopaedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, People's Republic of China.
authors.forename: Guang-Zhi
authors.initials: GZ
authors.lastname: Ning
authors.affiliation: Internal medicine of traditional Chinese medicine department, Jing 'an district central hospital of Shanghai, NO. 259, Xikang road, 200040, Shanghai, P.R. China.
authors.forename: Tian-Song
authors.initials: TS
authors.lastname: Zhang
authors.affiliation: Department of Orthopaedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, People's Republic of China.
authors.forename: Di
authors.initials: D
authors.lastname: Zhang
authors.affiliation: Department of Orthopaedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, People's Republic of China.
authors.forename: Shi-Qing
authors.initials: SQ
authors.lastname: Feng
mesh_terms: D019386:Alendronate / Q000008:administration & dosage / Q000009:adverse effects; D015519:Bone Density / Q000187:drug effects*; D050071:Bone Density Conservation Agents / Q000008:administration & dosage* / Q000009:adverse effects; D004164:Diphosphonates / Q000008:administration & dosage / Q000009:adverse effects; D050723:Fractures, Bone / Q000139:chemically induced* / Q000453:epidemiology; D006801:Humans; D006887:Hydroxycholecalciferols / Q000008:administration & dosage / Q000009:adverse effects; D000077557:Ibandronic Acid; D007093:Imidazoles / Q000008:administration & dosage / Q000009:adverse effects; D008159:Lumbar Vertebrae / Q000187:drug effects / Q000293:injuries*; D010024:Osteoporosis / Q000150:complications / Q000188:drug therapy*; D010281:Parathyroid Hormone / Q000008:administration & dosage / Q000009:adverse effects; D000068296:Risedronic Acid / Q000008:administration & dosage / Q000009:adverse effects; D019379:Teriparatide / Q000008:administration & dosage / Q000009:adverse effects; D013876:Thiophenes / Q000008:administration & dosage / Q000009:adverse effects; D000077211:Zoledronic Acid
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D006887:Hydroxycholecalciferols; D007093:Imidazoles; D010281:Parathyroid Hormone; D013876:Thiophenes; C081587:strontium ranelate; D019379:Teriparatide; D000077211:Zoledronic Acid; D000068296:Risedronic Acid; D000077557:Ibandronic Acid; C008088:alfacalcidol; D019386:Alendronate