Prevention of vertebral and non-vertebral fractures in postmenopausal women with anti-osteoporosis drugs：a network meta-analysis / 中国组织工程研究

ABSTRACT

BACKGROUND:Comparison of the incidence of fracture can be used as a manner to evaluate the therapeutic effects of anti-osteoporosis drugs. At present, there are a few network meta-analysis on different kinds of anti-osteoporosis drugs. OBJECTIVE:To comprehensively evaluate the risks of different anti-osteoporosis drugs in reducing the vertebral and non-vertebral fractures in postmenopausal women by applying Network Meta-analysis. METHODS: We retrieved The Cochrane Library, PubMed, EMbase, Wanfang, China Biology Medicine, VIP and China National Knowledge Infrastructure for randomized controled trials about vertebral and non-vertebral fractures in postmenopausal women taking anti-osteoporosis drugs. Retrieval time was from building a database to July 2014. Two reviewers extracted and assessed independently the outcomes and quality of included trials according to inclusion and exclusion criteria. We used random effects Bayesian models and fixed effects Bayesian model in WinBUGS 1.4.3 combined R 3.03 software in the network meta-analysis. RESULTS AND CONCLUSION:Forty-six randomized controled trials on vertebral fracture and forty-two randomized controled trials on non-vertebral risk reduction with bisphosphonates (alendronate, risedronate, ibandronate, etidronate, and zoledronic acid), parathyroid hormone (teriparatide), biologics (denosumab), or selective estrogen receptor modulators (raloxifene, bazedoxifene) were identified by a systematic review. Individual study results were pooled in a network meta-analysis to indirectly compare treatment effects in postmenopausal women. The odd ratio and 95% confidence interval of drugs were estimated using random effects Bayesian models in WinBUGS 1.4.3. Zoledronic acid was best in the prevention of vertebral fractures. Risedronate reduced the risk of non-vertebral fracture in postmenopausal women better than other drugs. However, current network meta-analysis cannot give a certain conclusion. A large perspective study designed specialy for confirmation is needed to confirm the results of our study.