Comparative effectiveness of bone-protective interventions for aromatase inhibitors-induced bone loss in postmenopausal women with early breast cancer: a network meta-analysis
Abstract
Objectives: This network meta-analysis (NMA) aims to compare the efficacy of bone-protective interventions in preventing AIs-induced bone loss at lumbar spine and hip sites.
Methods: We systematically searched PubMed, Embase, Cochrane Library, Web of Science, and clinical trial registries from inception to February 28, 2025, to identify randomized controlled trials (RCTs) evaluating bone-protective interventions in postmenopausal women with breast cancer receiving AI therapy. Primary outcomes were changes in bone mineral density (BMD) at lumbar spine and total hip at 12 and 24 months. Network meta-analysis was performed using Bayesian methods with R software and WinBUGS. Treatment rankings were assessed using surface under the cumulative ranking curve (SUCRA) values.
Results: Seventeen RCTs involving 6,932 postmenopausal patients were included, comparing six interventions: denosumab, alendronate, zoledronic acid, ibandronate, risedronate, and eldecalcitol plus risedronate. At 12 months, denosumab demonstrated superior lumbar spine BMD improvement (SUCRA = 0.88, WMD = 5.63, 95% CI: 4.67-6.59), while ibandronate showed optimal hip BMD preservation (SUCRA = 0.94, WMD = 4.23, 95% CI: 2.91-5.43). At 24 months, denosumab maintained its advantage for lumbar spine (SUCRA = 0.83, WMD = 7.96, 95% CI: 5.38-10.52), whereas eldecalcitol plus risedronate showed the highest SUCRA ranking for hip preservation (SUCRA = 0.83, WMD = 6.38, 95% CI: 3.38-9.61). All active interventions…
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: 6,932 participants or records.
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