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Meta-analysis for the efficacy of bisphosphonates on hip fracture prevention

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Abstract

The aim of this study was to investigate the effect of bisphosphonates on preventing osteoporotic hip fracture in patients with or without prior major osteoporotic fracture. Randomized controlled trials (RCTs) and observational studies (OSs) based on electronic health records were used to assess bisphosphonate efficacy and were searched using PubMed, Scopus, and the Cochrane Library databases. Eight RCT studies and 14 OSs were extracted from the studies and quantitatively combined by random-effects meta-analysis. The odds ratio (OR) for all hip fractures in RCTs of 0.66, with a 95% confidence interval (CI) of 0.55–0.79, was lower than that in the OSs (OR 0.83; CI 0.74–0.94). The OR in patients with prior fracture was significantly reduced by bisphosphonates in both RCTs and OSs. Conversely, significant fracture reduction was not apparent in patients without prior fracture. A moderate relationship between prior major fracture rates and OR in hip fractures was defined. In patients with an average age of over 80 years, similar results were confirmed. In this meta-analysis, the efficacy of bisphosphonates was significant in patients with prior major fracture, recommending to prescribe for such patients. Their effect in patients without prior fracture, in contrast, remains unclear.

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Acknowledgements

We are grateful to Prof. H. Yoshikawa, at Osaka University Graduate School of Medicine, for his critical reading and helpful comments on this article. We also thank Enago (www.enago.jp) for the English language review.

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This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Kansai Rosai Hospital, 3-1-69 Inabaso, Amagasaki, Hyogo, 660-8511, Japan

    Takayuki Tsuda, Yoshichika Hashimoto & Yasunori Okamoto

  2. Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Yamada-oka, Suita, Osaka, 565-0871, Japan

    Wataru Ando

  3. Department of Musculoskeletal Regenerative Medicine, Osaka University Graduate School of Medicine, Yamada-oka, Suita, Osaka, 565-0871, Japan

    Kosuke Ebina

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  1. Takayuki Tsuda
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Contributions

TT devised and designed the study. TT and YH searched for and reviewed the articles. TT wrote the paper. KE critically revised the work. All authors analyzed the results and approved the final version of the manuscript.

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Correspondence to Takayuki Tsuda.

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Conflict of interest

The authors declare no support from any organization for the submitted work. All authors, with the exception of Kosuke Ebina, have declared that no competing interests exist. Kosuke Ebina is affiliated with the Department of Musculoskeletal Regenerative Medicine, Osaka University, Graduate School of Medicine, which is supported by Taisho. Kosuke Ebina have received research grants from Asahi-Kasei, Astellas, Chugai, Daiichi Sankyo, Eisai, and Ono. Kosuke Ebina has received payments for lectures from Asahi-Kasei, Astellas, Chugai, Daiichi Sankyo, Eisai, Eli Lilly, and Ono.

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Tsuda, T., Hashimoto, Y., Okamoto, Y. et al. Meta-analysis for the efficacy of bisphosphonates on hip fracture prevention. J Bone Miner Metab 38, 678–686 (2020). https://doi.org/10.1007/s00774-020-01096-z

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