Bisphosphonates effective as first-line treatment for osteoporosis or ostopenia: Study

This meta-analysis and systematic review investigated the efficacy of bisphosphonates on the incidence of hip fracture (IHF) in patients of different ages with osteoporosis or osteopenia. We searched Web of Science, Embase, the Cochrane Database, and PubMed from inception to January 10, 2021, for trials reporting the effects of bisphosphonates on the incidence of hip fracture (IHF). The researchers included only randomized, double-blind, placebo-controlled clinical trials. The researchers pooled data using a random-effects meta-analysis with risk ratios (RRs) and reported 95% CIs. They also used the Cochran Q and I² statistics to assess the heterogeneity in the results of individual studies.

The primary endpoints were the total numbers of people in the bisphosphonates and placebo groups and the numbers of IHFs during the follow-up periods.

The results of the study are as follows:

Bisphosphonates reduced the IHF with an overall effect (RR: 0.66; 95% CI: 0.56 to 0.77; zoledronic acid: RR: 0.60; 95% CI: 0.46 to 0.78; risedronate: RR: 0.74; 95% CI: 0.59 to 0.94, and alendronate: RR: 0.61; 95% CI: 0.40 to 0.95). The result of the heterogeneity assessment was I²=0, p=0.97. In all age groups (all ages, ≥55 years old, ≥65 years old), bisphosphonates reduced the IHF. In the ≥55 years old and ≥65 years old age groups, the RR and 95% CI were 0.63 and 0.43 to 0.93, and 0.60 and 0.44 to 0.81, respectively. Bisphosphonate reduced the IHF in the general population and all age groups (≥55 years old and ≥65 years old). Zoledronic acid, risedronate and alendronate reduced the IHF in osteoporosis or osteopenia populations. The association between bisphosphonate and the IHF does not appear to be influenced by age.

These findings indicate that bisphosphonates can be recommended as a first-line treatment for the prevention and treatment of osteoporosis and can decrease the risk of hip fracture among the general population, the authors concluded.

Reference:

Zhao S, Zhao W, Du D, Zhang C, Zhao T, Zheng L, et al. Effect of bisphosphonate on hip fracture in patients with osteoporosis or osteopenia according to age: a meta-analysis and systematic review. J Investig Med 2021:jim-2021-001961.

https://doi.org/10.1136/jim-2021-001961.