Comparative efficacy and safety of antiresorptive and anabolic therapies for male osteoporosis: an updated Bayesian network meta-analysis
Abstract
Background: Osteoporosis in men is an increasingly recognized health issue associated with reduced bone mineral density (BMD) and elevated fracture risk. While both antiresorptive and anabolic therapies are recommended in clinical practice, evidence directly comparing these drug classes in male populations remains limited.
Methods: We performed a systematic review and Bayesian network meta-analysis (NMA), registered on PROSPERO (CRD420251151177), to assess the efficacy and safety of pharmacological interventions for male osteoporosis. Randomized controlled trials (RCTs) evaluating alendronate, risedronate, zoledronic acid, denosumab, teriparatide, or abaloparatide were identified from PubMed, Web of Science, and the Cochrane Library through 2025. Primary outcomes included percent change in lumbar spine, femoral neck, and total hip BMD at 12 months. Safety outcomes were all adverse events (AEs) and serious adverse events (SAEs). Category-level meta-analyses were further conducted to compare pooled effects of antiresorptive versus anabolic agents.
Results: Eighteen RCTs comprising 19-1199 participants each were included. At the drug level, abaloparatide and teriparatide ranked highest for lumbar spine BMD, while alendronate and abaloparatide demonstrated the most favorable effects for femoral neck and total hip BMD, respectively. Safety profiles were broadly similar, with teriparatide and alendronate showing relatively lower risks of AEs and SAEs. At the class level, anabolic…
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: 1,199 participants or records.
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