Comparative efficacy and safety of odanacatib, abaloparatide, denosumab, teriparatide, and bisphosphonates for male osteoporosis: a systematic review and network meta-analysis
Abstract
Background: Evidence from randomized controlled trials (RCTs) on pharmacological management of primary osteoporosis in men is fragmented, making direct comparisons across drug classes difficult, and head-to-head evidence remains limited. We performed a network meta-analysis (NMA) to compare the relative efficacy and safety of commonly used anti-osteoporotic agents in men.
Methods: We systematically searched PubMed, Web of Science, and the Cochrane Library from inception to December 2025 for RCTs enrolling men with primary osteoporosis. Eligible interventions included oral bisphosphonates (OBP), intravenous bisphosphonates (IBP), abaloparatide (ABA), denosumab (DEN), teriparatide (TER), and odanacatib (ODN), compared with placebo/usual care (PLA/CTRL) or active treatments. Primary efficacy outcomes were changes in bone mineral density (BMD) at the lumbar spine (LS), total hip (TH), and femoral neck (FN), preferentially extracted at the time point closest to 12 months (range: 6-24 months). Safety outcomes were any adverse events (AEs) and serious adverse events (SAEs). Pairwise meta-analyses were conducted in Stata 18.0, and NMA in R 4.3.1 under a consistency framework. Treatments were ranked using SUCRA. The protocol was registered in PROSPERO (CRD420261279572).
Results: Twenty-one RCTs (n = 4,409) were included. Compared with PLA/CTRL, TER and ABA significantly improved FN-BMD (TER: MD 2.97, 95% CI 0.74-5.20; ABA: MD 2.83, 95% CI 0.11-5.55), and OBP also showed benefit (MD…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 4,409 participants or records.
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