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Efficacy of Antiresorptive Treatment in Osteoporotic Older Adults: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.
- Source :
-
The journal of nutrition, health & aging [J Nutr Health Aging] 2022; Vol. 26 (8), pp. 778-785. - Publication Year :
- 2022
-
Abstract
- Objectives: To investigate concerns surrounding the benefits of antiresorptive drugs in older adults, a systematic review was carried out to evaluate the efficacy of these treatments in the prevention of osteoporotic hip fractures in older adults.<br />Design: a systematic review and meta-analysis of randomized clinical trials.<br />Setting and Participants: older adults ≥65 years with osteoporosis, with or without a previous fragility fracture. Studies with cancer-related and corticosteroid-induced osteoporosis, participants <65 years and no reported hip fracture were not included.<br />Methods: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, ISI Web of Science and Scopus databases were searched. The primary outcome was hip fracture, and subgroup analysis (≥75 years, with different drug types and secondary prevention) and sensitivity analysis was carried out using a GRADE evaluation. Secondary outcomes were any type of fractures, vertebral fracture, bone markers and adverse events. The risk of bias was assessment with the Cochrane risk of bias tool.<br />Results: A total of 12 randomised controlled trials (RCTs) qualified for this meta-analysis, with 36,196 participants. Antiresorptive drugs have a statistically significant effect on the prevention of hip fracture (RR=0.70; 95%CI 0.60 to 0.81), but with a moderate GRADE quality of evidence and a high number needed to treat (NNT) of 186. For other outcomes, there is a statistically significant effect, but with a low to moderate quality of evidence. Antiresorptives showed no reduction in the risk of hip fracture in people ≥75 years. The results for different drug types, secondary prevention and sensitivity analysis are similar to the main analyses and have the same concerns.<br />Conclusions: Antiresorptive drugs have a statistically significant effect on preventing hip fracture but with a moderate quality (unclear/high risk of bias) and high NNT (186). This small benefit disappears in those ≥75 years, but increases in secondary prevention. More RCTs in very old osteoporotic adults are needed.<br />Competing Interests: None declared.
- Subjects :
- Aged
Humans
Randomized Controlled Trials as Topic
Bone Density Conservation Agents adverse effects
Hip Fractures drug therapy
Hip Fractures etiology
Hip Fractures prevention & control
Osteoporosis complications
Osteoporosis drug therapy
Osteoporosis prevention & control
Osteoporotic Fractures prevention & control
Spinal Fractures drug therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1760-4788
- Volume :
- 26
- Issue :
- 8
- Database :
- MEDLINE
- Journal :
- The journal of nutrition, health & aging
- Publication Type :
- Academic Journal
- Accession number :
- 35934822
- Full Text :
- https://doi.org/10.1007/s12603-022-1825-5