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Efficacy of Antiresorptive Treatment in Osteoporotic Older Adults: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

Abstract

Objectives

To investigate concerns surrounding the benefits of antiresorptive drugs in older adults, a systematic review was carried out to evaluate the efficacy of these treatments in the prevention of osteoporotic hip fractures in older adults.

Design

A systematic review and meta-analysis of randomized clinical trials.

Setting and Participants

Older adults ≥65 years with osteoporosis, with or without a previous fragility fracture. Studies with cancer-related and corticosteroid-induced osteoporosis, participants <65 years and no reported hip fracture were not included.

Methods

MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, ISI Web of Science and Scopus databases were searched. The primary outcome was hip fracture, and subgroup analysis (≥75 years, with different drug types and secondary prevention) and sensitivity analysis was carried out using a GRADE evaluation. Secondary outcomes were any type of fractures, vertebral fracture, bone markers and adverse events. The risk of bias was assessment with the Cochrane risk of bias tool.

Results

A total of 12 randomised controlled trials (RCTs) qualified for this meta-analysis, with 36,196 participants. Antiresorptive drugs have a statistically significant effect on the prevention of hip fracture (RR=0.70; 95%CI 0.60 to 0.81), but with a moderate GRADE quality of evidence and a high number needed to treat (NNT) of 186. For other outcomes, there is a statistically significant effect, but with a low to moderate quality of evidence. Antiresorptives showed no reduction in the risk of hip fracture in people ≥75 years. The results for different drug types, secondary prevention and sensitivity analysis are similar to the main analyses and have the same concerns.

Conclusions

Antiresorptive drugs have a statistically significant effect on preventing hip fracture but with a moderate quality (unclear/high risk of bias) and high NNT (186). This small benefit disappears in those ≥75 years, but increases in secondary prevention. More RCTs in very old osteoporotic adults are needed.

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Data Availability: All data generated or analysed during this study (template data collection forms; data extracted from included studies; data used for all analyses; analytic code) are included in this article or its supplementary material files. The review protocol can be accessed on the PROSPERO database (CRD42020165960). Further enquiries can be directed to the corresponding author.

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Acknowledgements

The authors would like to thank the partners from the Unit of Innovation and Organization for reviewing drafts of this manuscript.

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

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Correspondence to Bernardo Abel Cedeno-Veloz.

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Cedeno-Veloz, B.A., Erviti Lopez, J., Gutiérrez-Valencia, M. et al. Efficacy of Antiresorptive Treatment in Osteoporotic Older Adults: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. J Nutr Health Aging 26, 778–785 (2022). https://doi.org/10.1007/s12603-022-1825-5

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Key words

  • Age-related changes
  • bone
  • drug-related
  • hip fracture
  • osteoporosis