Comparative Effectiveness of Drug Treatments to Prevent Fragility Fractures: A Systematic Review and Network Meta-Analysis

Context: Osteoporosis and osteopenia are associated with increased fracture incidence. Objective: The aim of this study was to determine the comparative effectiveness of different pharmacological agents in reducing the risk of fragility fractures. Data Sources: We searched multiple databases through 12/9/2011. Study Selection: Eligible studies were randomized controlled trials enrolling individuals at risk of developing fragility fractures and evaluating the efficacy of bisphosphonates, teriparatide, selective estrogen receptor modulators, denosumab, or calcium and vitamin D. Data Extraction: Reviewers working independently and in duplicate determined study eligibility and collected descriptive, methodological quality, and outcome data. Data Synthesis: This network meta-analysis included 116 trials (139,647 patients; median age, 64 yr; 86% females and 88% Caucasians; median follow-up, 24 months). Trials were at low to moderate risk of bias. Teriparatide had the highest risk reduction of fractures (odds ra...