title: Network Meta-Analysis of Pharmacological Agents for Osteoporosis Treatment and Fracture Prevention.
abstract: OBJECTIVE
  Osteoporosis afflicts a large number of populations in the world and is featured by systemic impairment of bone mass and strength which may further trigger an increase in the risk of fragile fractures. This network meta-analysis (NMA) is designed to distinguish therapies more preferable than others with respect to efficacy and safety.
  
  
  METHODS
  We searched the medical literature for relevant studies systematically. Both direct and indirect evidence were synthesized to compare the efficacy, described by odds ratios (OR) and 95% credible intervals (CrI). Moreover, the surface under cumulative ranking curve was calculated to rank probabilities with respect to clinical outcomes. The new non-vertebral fractures, hip and wrist fractures, and adverse events were evaluated in this NMA.
  
  
  RESULTS
  Patients treated by alendronate, denosumab, teriparatide were associated with a reduced risk of new non-vertebral fractures compared to those treated by placebo. Alendronate, denosumab and zoledronic acid had better efficacy in preventing hip fractures. With respect to wrist fractures prevention, no significant difference was observed. Zoledronic acid exhibited significantly increased risk of adverse events than placebo, alendronate, denosumab, and raloxifene. According to SUCRA, teriparatide ranked highest in new non-vertebral fractures prevention, etidronate and denosumab balanced safety and efficacy well.
  
  
  CONCLUSIONS
  In summary, teriparatide appeared to be the most efficacious drug for preventing new non-vertebral fractures, while etidronate and denosumab were preferable for balancing safety and efficacy well.
authors.affiliation: Department of Orthopaedics, Xiangya Hospital of Central South University, Changsha, P.R. China.
authors.forename: Xu-Cheng
authors.initials: XC
authors.lastname: Yang
authors.forename: Zhen-Han
authors.initials: ZH
authors.lastname: Deng
authors.forename: Ting
authors.initials: T
authors.lastname: Wen
authors.forename: Wei
authors.initials: W
authors.lastname: Luo
authors.forename: Wen-Feng
authors.initials: WF
authors.lastname: Xiao
authors.forename: Rui-Bo
authors.initials: RB
authors.lastname: Zhao
authors.forename: Yu-Sheng
authors.initials: YS
authors.lastname: Li
mesh_terms: D050071:Bone Density Conservation Agents / Q000009:adverse effects / Q000627:therapeutic use*; D050723:Fractures, Bone / Q000188:drug therapy* / Q000517:prevention & control*; D006801:Humans; D016017:Odds Ratio; D010024:Osteoporosis / Q000188:drug therapy*
chemical_list: D050071:Bone Density Conservation Agents