Pharmacologic intervention for prevention of fractures in osteopenic and osteoporotic postmenopausal women: Systemic review and meta-analysis
Chih-Hsing Wu,
Wei-Chieh Hung,
Ing-Lin Chang,
Tsung-Ting Tsai,
Yin-Fan Chang,
Eugene V. McCloskey,
Nelson B. Watts,
Michael R. McClung,
Chun-Feng Huang,
Chung-Hwan Chen,
Kun-Ling Wu,
Keh-Sung Tsai,
Ding-Cheng Chan,
Jung-Fu Chen,
Shih-Te Tu,
Jawl-Shan Hwang,
Weibo Xia,
Toshio Matsumoto,
Yoon-Sok Chung,
Cyrus Cooper,
John A. Kanis,
Rong-Sen Yang,
Wing P. Chan
Affiliations
Chih-Hsing Wu
Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Institute of Geriatrics, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Correspondence to: C-H. Wu, Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Wei-Chieh Hung
Department of Family Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan; Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung, Taiwan; Medicine for International Student, I-Shou University, Kaohsiung, Taiwan
Ing-Lin Chang
Department of Orthopaedics, ChangHua Christian Hospital, ChangHua, Taiwan
Tsung-Ting Tsai
Department of Orthopedics, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taiwan
Yin-Fan Chang
Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
Eugene V. McCloskey
Academic Unit of Bone Metabolism, University of Sheffield, Sheffield, UK
Nelson B. Watts
Mercy Health Osteoporosis and Bone Health Services, Cincinnati, OH, USA
Michael R. McClung
The Oregon Osteoporosis Center, Portland, OR, USA
Chun-Feng Huang
Department of Family Medicine, National Yang Ming University Hospital, I-Lan, Taiwan
Chung-Hwan Chen
Orthopaedic Research Centre, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Orthopaedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Orthopaedics, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung City, Taiwan; Institute of Medical Science and Technology, National Sun Yat-Sen University, Kaohsiung, Taiwan
Kun-Ling Wu
Department of Family Medicine, Tainan Municipal Hospital (Managed by Show Chwan Medical Care Corporation), Tainan City, Taiwan; Outpatient Clinic Department, Tainan Municipal Hospital (Managed by Show Chwan Medical Care Corporation), Tainan City, Taiwan
Keh-Sung Tsai
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
Ding-Cheng Chan
Superintendent Office, National Taiwan University Hospital Chu-Tung Branch, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan
Jung-Fu Chen
Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
Shih-Te Tu
Division of Endocrinology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
Jawl-Shan Hwang
Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taiwan
Weibo Xia
Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
Toshio Matsumoto
Fujii Memorial Institute of Medical Sciences, University of Tokushima, Japan
Yoon-Sok Chung
Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, South Korea
Cyrus Cooper
MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK; Oxford National Institute for Health Research Biomedical Research Centre, University of Oxford, Oxford, UK
John A. Kanis
Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia; Centre for Metabolic Bone Diseases, University of Sheffield Medical School, UK
Rong-Sen Yang
Department of Orthopaedics, College of Medicine, National Taiwan University & Hospital, Taipei, Taiwan
Wing P. Chan
Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Correspondence to: W P. Chan, Department of Radiology, Wan Fang Hospital, Taipei Medical University, 111 Hsing-Long Road, Section 3, Taipei 116, Taiwan.
Objectives: Emerging evidence has indicated a role for pharmacologic agents in the primary prevention of osteoporotic fracture, but have not yet been systematically reviewed for meta-analysis. We conducted a meta-analysis to evaluate the efficacy of pharmacologic interventions in reducing fracture risk and increasing bone mineral density (BMD) in postmenopausal women with osteopenia or osteoporosis but without prevalent fragility fracture. Method: The Medline, EMBASE, and CENTRAL databases were searched from inception to September 30, 2019. Only randomized placebo-controlled trials evaluating postmenopausal women with −1.0 > bone mineral density (BMD) T-score > −2.5 (low bone mass) and those with BMD T-score ≤ −2.5 (osteoporosis) but without baseline fractures, who were receiving anti-osteoporotic agents, providing quantitative outcomes data and evaluating risk of vertebral and/or non-vertebral fragility fracture at follow-up. The PRISMA guidelines were followed, applying a random-effects model. The primary endpoint was the effect of anti-osteoporotic regimens in reducing the incidence of vertebral fractures. Secondary endpoints were percentage changes in baseline BMD at the lumbar spine and total hip at 1 and 2 years follow up. Results: Full-text review of 144 articles yielded, 20 for meta-analysis. Bisphosphonates reduced the risk of vertebral fracture (pooled OR = 0.50, 95%CIs = 0.36–0.71) and significantly increased lumbar spine BMD after 1 year, by 4.42% vs placebo (95%CIs = 3.70%–5.14%). At the hip, this value was 2.94% (95%CIs = 2.13%–3.75%). Overall results of limited studies for non-bisphosphonate drugs showed increased BMD and raloxifene significantly decreases the risk of subsequent clinical vertebral fractures. Conclusion: The bisphosphonates are efficacious and most evident for the primary prevention of osteoporotic vertebral fractures, reducing their incidence and improving BMD in postmenopausal women with osteopenia or osteoporosis.
