Effectiveness of anabolic and anti-resorptive agents for preventing postmenopausal osteoporosis fractures: a systematic review and network meta-analysis
Abstract
Background: While anabolic agents are highly effective in stimulating bone formation, their benefits are transient and tend to plateau after prolonged use. This necessitates a transition to anti-resorptive therapies. We aimed to estimate anti-osteoporosis effect and compliance of different anabolic and anti-resorptive agents to explore the optimal cycling strategy.
Methods: PubMed, Embase, Web of Science, and Cochrane Library were searched for randomized controlled trials comparing anabolic or anti-resorptive agents with placebo or each other in postmenopausal women with osteoporosis or osteopenia, reporting outcomes on bone mineral density (BMD) change, fracture incidence, or treatment discontinuation from inception to February 1, 2024. The frequentist random-effect model for network meta-analysis was performed to summarize the evidence, and the Grading of Recommendations Assessment, Development, and Evaluation frameworks was applied to rate the certainty of evidence.
Results: A total of 16,231 citations were identified, and 227 trials with 140,230 participants met the inclusion criteria. The anti-sclerostin (AS) antibody was the most effective anabolic agent, significantly increasing BMD at the femoral neck (Mean difference (MD): 6.00; 95% confidence interval (CI): 3.34-8.66) and spine (MD: 13.30; 95% CI: 9.15-17.45), and reducing spine and hip fracture risk (OR: 0.27; 95% CI: 0.15-0.47) at 12 months without a significant increase in discontinuation (OR: 0.88; 95% CI:…
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: 140,230 participants or records.
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