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Meta-Analysis
. 2024 Apr;46(2):357-367.
doi: 10.1007/s11096-023-01666-x. Epub 2023 Dec 19.

The effectiveness of ibandronate in reducing the risk of nonvertebral fractures in women with osteoporosis: systematic review and meta-analysis of observational studies

Carlos Alves  1   2 , Diogo Mendes  3   4 , Ana Penedones  3   4 , Tânia Oliveira  5 , António Donato  3   5 , Francisco Batel-Marques  3   4
Affiliations
Meta-Analysis

The effectiveness of ibandronate in reducing the risk of nonvertebral fractures in women with osteoporosis: systematic review and meta-analysis of observational studies

Carlos Alves et al. Int J Clin Pharm. 2024 Apr.

Abstract

Background: Ibandronate is effective in reducing the risk of vertebral fractures, but experimental evidence offers conflicting results regarding nonvertebral fractures. Real-world evidence has been published evaluating the anti-nonvertebral fracture effect of ibandronate.

Aim: This meta-analysis of observational studies assessed the effectiveness of ibandronate in reducing the risk of nonvertebral fractures in women with osteoporosis.

Method: Pubmed/Embase databases were searched for observational studies. Risks of nonvertebral fractures and hip fractures were the outcomes. Meta-analyses were performed pooling rate ratios (RRs), using random-effects models. Data were reanalysed in sensitivity analyses considering Knapp-Hartung method and Bayesian random-effects.

Results: Six cohort studies were included. Overall, once-monthly 150 mg oral ibandronate reduced the risk of nonvertebral fractures (RR 0.84; 95% CI 0.76-0.94). Similar results were obtained when the comparison was restricted to once-monthly 150 mg risedronate, but no differences were found when the comparator was other oral bisphosphonates (weekly alendronate/risedronate). Ibandronate didn't significantly change the risk of hip fractures (RR 1.25; 95% CI 0.89-1.76). The risk of hip fracture was comparable between once monthly, 150 mg oral ibandronate and other oral bisphosphonates. Intravenous ibandronate was not effective in reducing hip fractures comparing to intravenous zoledronate. The low number of studies diminished the robustness of sensitivity analyses.

Conclusion: Results suggest that once-monthly 150 mg oral ibandronate may be as effective as other oral bisphosphonates in reducing the risk of nonvertebral fractures. However, uncertainty associated to the small number of included studies, which are characterized by heterogeneous demographics and methodologies, precluded definitive conclusions.

Keywords: Ibandronic acid; Meta-analysis; Observational study; Osteoporosis; Osteoporotic fractures; Systematic review.

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Conflict of interest statement

António Donato and Tânia Oliveira are employees of Tecnimede, SA. There is no other conflict of interests do declare.

Figures

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Fig. 1
PRISMA flowchart
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Fig. 2
Risk of bias using the ROBINS-I tool
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Fig. 3
Meta-analysis of the risk of nonvertebral fractures
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Fig. 4
Meta-analysis of the risk of hip fractures
See this image and copyright information in PMC

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