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Meta-Analysis
. 2022;26(8):778-785.
doi: 10.1007/s12603-022-1825-5.

Efficacy of Antiresorptive Treatment in Osteoporotic Older Adults: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

B A Cedeno-Veloz  1 , J Erviti Lopez, M Gutiérrez-Valencia, L Leache Alegría, L C Saiz, A M Rodríguez García, M Sánchez Latorre, R Ramírez Vélez, M Izquierdo, N Martínez-Velilla
Affiliations
Meta-Analysis

Efficacy of Antiresorptive Treatment in Osteoporotic Older Adults: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

B A Cedeno-Veloz et al. J Nutr Health Aging. 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.

Design: a systematic review and meta-analysis of randomized clinical trials.

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.

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.

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.

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.

Keywords: Age-related changes; bone; drug-related; hip fracture; osteoporosis.

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Conflict of interest statement

None declared.

Figures

Figure 1
Figure 1
PRISMA flow chart of search results and included studies
Figure 2
Figure 2
Graph showing the risk of bias
Figure 3
Figure 3
Forest plot for primary analysis of hip fracture in older adults
See this image and copyright information in PMC

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