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Many Agents Help Prevent Osteoporotic Fractures

Systematic review of drug treatments finds insufficient evidence for comparisons

TUESDAY, Dec. 18 (HealthDay News) -- A systematic review of studies on pharmacological treatments for preventing fractures in patients with osteoporosis identified numerous effective agents but found insufficient evidence to make comparisons between them, according to a report published online Dec. 18 in the Annals of Internal Medicine.

Catherine MacLean, M.D., Ph.D., of the Greater Los Angeles Veterans Administration Healthcare System, and colleagues completed a comprehensive database search of English-language studies pertaining to the various classes of pharmacotherapies for osteoporosis. The review was completed under contract for the Agency for Healthcare Research and Quality. Agents evaluated were bisphosphonates (alendronate, etidronate, ibandronate, pamidronate, risedronate and zoledronic acid), calcitonin, estrogen, teriparatide, selective estrogen-receptor modulators (raloxifene and tamoxifen), testosterone, vitamin D and calcium.

Good evidence was found that alendronate, etidronate, ibandronate, risedronate, zoledronic acid, estrogen, parathyroid hormone and raloxifene helped prevent vertebral fractures, relative to placebo. Good evidence also suggested that alendronate, risedronate and estrogen helped prevent hip fractures. Efficacy of vitamin D varied according to study population and methodology. An analysis of adverse effects found an increased risk of thromboembolic events with raloxifene, estrogen and estrogen-progestin, and an increased risk of gastrointestinal complications with etidronate.

"In summary," the authors conclude, "although good evidence indicates that many agents are effective in preventing osteoporotic fractures, data are insufficient to determine the relative efficacy or safety of these agents."

MacLean is an employee of WellPoint. Another author of the study owns stock in Johnson & Johnson.

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