Comparison of Bone Mineral Density in Lumbar Spine and Fracture Rate among Eight Drugs in Treatments of Osteoporosis in Men: A Network Meta-Analysis

Ling-Xiao Chen, Zhi-Rui Zhou, Yu-Lin Li, Guang-Zhi Ning, Tian-Song Zhang, Di Zhang, Shi-Qing Feng, Ling-Xiao Chen, Zhi-Rui Zhou, Yu-Lin Li, Guang-Zhi Ning, Tian-Song Zhang, Di Zhang, Shi-Qing Feng

Abstract

Context: 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.

Data sources: 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.

Study selection: 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.

Data extraction: Two authors independently extracted the data.

Data synthesis: 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.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. PRISMA flow diagram.
Fig 1. PRISMA flow diagram.
Fig 2. Risk of bias graph and…
Fig 2. Risk of bias graph and summary.
Panel A: Risk of bias graph: review authors’ judgments about each risk of bias item presented as percentages across all included studies. Panel B: Risk of bias summary: review authors’ judgments about each risk of bias item for each included study.
Fig 3. Network of treatment comparisons.
Fig 3. Network of treatment comparisons.
The size of the nodes represents the total sample size of treatments. The lines’ thickness corresponds to the number of trials that compare each other. Panel A: Network of treatment comparisons for the BMD in LS. Panel B: Network of treatment comparisons for the fracture rate. ALE: Alendronate; PLA: Placebo; ALF: Alfacalcidol; RIS: Risedronate; IBA: Ibandronate; ZOL: Zoledronate; STR: Strontium Ranelate; TER: Teriparatide; PTH: Parathyroid Hormone.
Fig 4. Pooled SMD for the BMD…
Fig 4. Pooled SMD for the BMD in LS by Bayesian network meta-analysis and traditional meta-analysis.
ALE: Alendronate; PLA: Placebo; ALF: Alfacalcidol; RIS: Risedronate; IBA: Ibandronate; ZOL: Zoledronate; STR: Strontium Ranelate; TER: Teriparatide; PTH: Parathyroid Hormone.
Fig 5. Ranking of treatments in terms…
Fig 5. Ranking of treatments in terms of the BMD in LS and fracture rate.
ALE: Alendronate; PLA: Placebo; ALF: Alfacalcidol; RIS: Risedronate; IBA: Ibandronate; ZOL: Zoledronate; STR: Strontium Ranelate; TER: Teriparatide; PTH: Parathyroid Hormone.

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