Journal of Endocrinological Investigation

, Volume 37, Issue 8, pp 769–773 | Cite as

Anti-reabsorptive agents in women with osteoporosis: determining statistical equivalence according to evidence-based methods

  • Andrea MessoriEmail author
  • Valeria Fadda
  • Dario Maratea
  • Sabrina Trippoli
  • Claudio Marinai
Rapid Communication



In the present study, we undertook an equivalence analysis on the effectiveness of the main anti-reabsorptive agents indicated for women with osteoporosis.


Our methodology was a combination of meta-analysis (both pair-wise meta-analysis and network meta-analysis) and equivalence testing. The end-point was the incidence on new vertebral fractures. The anti-reabsorptive agents examined included alendronate, zoledronate, ibandronate, risedronate, and denosumab.


Our analysis involved nine randomized trials. Ten head-to-head indirect comparisons were examined through network meta-analysis and the respective values of RR were estimated. The 95 % confidence intervals for RR remained within the interval of a relative ±40 % variation for all comparisons that involved alendronate, risedronate, ibandronate, and denosumab. In contrast, the comparisons involving zoledronate satisfied a post hoc margin up to ±67 %.


Our results confirm that most of these anti-reabsorptive drugs (namely, alendronate, risedronate, ibandronate, and denosumab) are equivalent according to reasonable equivalence margins.


Meta-analysis Equivalence Osteoporosis Ibandronate Alendronate Risedronate Denosumab 


Conflict of interest



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Copyright information

© Italian Society of Endocrinology (SIE) 2014

Authors and Affiliations

  • Andrea Messori
    • 1
    Email author
  • Valeria Fadda
    • 1
  • Dario Maratea
    • 1
  • Sabrina Trippoli
    • 1
  • Claudio Marinai
    • 2
  1. 1.HTA UnitArea Vasta Centro Toscana Regional Health SystemFlorenceItaly
  2. 2.Department of Pharmaceutical LogisticsESTAV Toscana Centro, Regional Health ServiceFlorenceItaly

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