Nandrolone Decanoate for Postmenopausal Osteoporosis: A Systematic Review and Meta-Analysis of Randomized Trials
Abstract
Postmenopausal osteoporosis is often accompanied by reduced muscle mass and chronic bone pain, amplifying fracture risk and functional decline. Nandrolone decanoate (ND), a synthetic anabolic steroid, has been proposed as a dual-acting agent that may benefit both bone and muscle through osteoanabolic and myoanabolic mechanisms, yet its therapeutic value in osteoporosis remains uncertain. We conducted a systematic review and meta-analysis of randomized controlled trials comparing ND with placebo in postmenopausal women with primary osteoporosis. The review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines and was prospectively registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD420251147647). Seven trials with 293 participants were included, with sample sizes varying by outcome. ND reduced fracture risk compared with placebo (moderate-certainty evidence). It produced modest increases in bone mineral density (BMD; low certainty) and more substantial gains in forearm bone mineral content (BMC; moderate certainty). ND also reduced pain (moderate certainty) and increased muscle mass (moderate certainty). However, ND was associated with a higher incidence of mostly mild virilizing adverse events (hirsutism, acne, voice changes; low certainty). Given the small sample sizes and methodological limitations of older trials, ND may be considered as a potential adjuvant option for selected…
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: 293 participants or records.
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