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|Title: ||Differing effects on hip and nonspine fracture risk reduction among N-containing bisphosphonates: Review and meta-analysis|
|Authors: ||Liberman, UA|
|Issue Date: ||2006|
|Publisher: ||SPRINGER LONDON LTD|
|Citation: ||OSTEOPOROSIS INTERNATIONAL, 17. p. S222-S223|
|Abstract: ||Objectives: N-containing bisphosphonates reduce the risk of vertebral fractures (VFx): however, results have not shown consistent effects on hip and other nonspine fractures. Systematic reviews are useful to summarize effects that often vary among individual trials, and meta-analysis provides a more precise estimate when results are consistent across pooled trials.(1) Methods: We surveyed earlier systematic reviews and meta-analyses ogether with subsequent reports (2-4) of randomized, placebo-controlled trials with data on nonspine and/or hip fractures, and used meta-analysis where appropriate to test for heterogeneity and derive pooled estimates. Results: For risedronate (RIS) (n=12958 subjects in trials), the
relative risk (RR) reduction was 27% for nonspine fracture
(RR=0.73; 95% CI= 0.61, 0.87)1 and 26% for hip fracture
(RR=0.74; 0.58, 0.94); there was no signiﬁcant interaction of
treatment and age >80 and there was no heterogeneity by dose (2.5
or 5 mg/day). For alendronate (ALN), heterogeneity existed; doses
>10 mg/day were signiﬁcantly more eﬀective for reduction of
nonspine and hip fracture. The RR reduction with ALN >10 mg
(n=3723) was 49% for nonspine fractures (RR=0.51; 0.38, 0.69).1
The RR reduction for hip fracture was 55% (RR=0.45; 0.28, 0.71)
when osteoporotic women in FIT (ALN 5 mg/day in years 1–2
then 10 mg/day for remainder of trial) were included (n=6804), and
55% (RR=0.45; 0.18, 1.13) for doses >10 mg/day (n=3723).1 One
post-hoc analysis suggested an eﬀect of ibandronate (IBN) on non-spine fractures in patients with severe osteoporosis, but the limited fracture data and differences in dosing precluded pooling studies for meta-analysis. No data are available on the effect of IBN on hip fracture. Consequently, there is no consistent evidence of hip or nonspine fracture risk reduction available for meta-analysis. No data are available on the effect of IBN on hip fracture. Consequently, there is no consistent evidence of hip or nonspine fracture risk reduction available for meta-analysis with IBN at a dose of 2.5 mg/day.(4)
Conclusions: The magnitude of eﬀect on hip fracture appears to
diﬀer among drugs. Based on current data, ALN reduces the risk
of hip and nonspine fracture by 49–55% and RIS by 26–27%.
There is insuﬃcient and/or inconsistent evidence of an eﬀect on
these fractures for ibandronate.(4)
1. Cranney et al. Endocr Rev 2002;23:570–8.
2. Papapoulos Osteoporos Int 2005;16:468–74.
3. McClung et al. NEJM 2001;344:333–40.
4. Chesnut et al. JBMR 2004;19:1241–9.|
|Notes: ||Tel Aviv Univ, Sackler Sch Med, Felsenstein Med Res Ctr, Dept Physiol & Pharmacol, IL-69978 Tel Aviv, Israel. Univ Maryland, Sch Med, Dept Med, Div Rheumatol & Clin Immunol, Baltimore, MD 21201 USA. Limburgs Univ Ctr, Biomed Res Inst, Diepenbeek, Belgium. Limburgs Univ Ctr, Biomed Res Inst, Maastricht, Netherlands. Merck & Co Inc, Merck Res Labs, Rahway, NJ 07065 USA.|
|ISI #: ||000245980600294|
|Type: ||Journal Contribution|
|Appears in Collections: ||Research publications|
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