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

doi:10.1016/j.bonr.2020.100729

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 CooperJohn A. Kanis, Rong Sen Yang, Wing P. Chan

Research output: Contribution to journal › Article › peer-review

15 Citations (Scopus)

Abstract

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.

Original language	English
Article number	100729
Journal	Bone Reports
Volume	13
DOIs	https://doi.org/10.1016/j.bonr.2020.100729
Publication status	Published - Dec 2020

Keywords

Fracture
Low bone mass
Osteopenia
Osteoporosis
Primary prevention

ASJC Scopus subject areas

Endocrinology, Diabetes and Metabolism
Orthopedics and Sports Medicine

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.bonr.2020.100729

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Wu, C. H., Hung, W. C., Chang, I. L., Tsai, T. T., Chang, Y. F., McCloskey, E. V., Watts, N. B., McClung, M. R., Huang, C. F., Chen, C. H., Wu, K. L., Tsai, K. S., Chan, D. C., Chen, J. F., Tu, S. T., Hwang, J. S., Xia, W., Matsumoto, T., Chung, Y. S., ... Chan, W. P. (2020). Pharmacologic intervention for prevention of fractures in osteopenic and osteoporotic postmenopausal women: Systemic review and meta-analysis. Bone Reports, 13, Article 100729. https://doi.org/10.1016/j.bonr.2020.100729

Wu, CH, Hung, WC, Chang, IL, Tsai, TT, Chang, YF, McCloskey, EV, Watts, NB, McClung, MR, Huang, CF, Chen, CH, Wu, KL, Tsai, KS, Chan, DC, Chen, JF, Tu, ST, Hwang, JS, Xia, W, Matsumoto, T, Chung, YS, Cooper, C, Kanis, JA, Yang, RS & Chan, WP 2020, 'Pharmacologic intervention for prevention of fractures in osteopenic and osteoporotic postmenopausal women: Systemic review and meta-analysis', Bone Reports, vol. 13, 100729. https://doi.org/10.1016/j.bonr.2020.100729

@article{80a73b8d7dd94ee1bd4dff97ceab4905,

title = "Pharmacologic intervention for prevention of fractures in osteopenic and osteoporotic postmenopausal women: Systemic review and meta-analysis",

abstract = "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.",

keywords = "Fracture, Low bone mass, Osteopenia, Osteoporosis, Primary prevention",

author = "Wu, {Chih Hsing} and Hung, {Wei Chieh} and Chang, {Ing Lin} and Tsai, {Tsung Ting} and Chang, {Yin Fan} and McCloskey, {Eugene V.} and Watts, {Nelson B.} and McClung, {Michael R.} and Huang, {Chun Feng} and Chen, {Chung Hwan} and Wu, {Kun Ling} and Tsai, {Keh Sung} and Chan, {Ding Cheng} and Chen, {Jung Fu} and Tu, {Shih Te} and Hwang, {Jawl Shan} and Weibo Xia and Toshio Matsumoto and Chung, {Yoon Sok} and Cyrus Cooper and Kanis, {John A.} and Yang, {Rong Sen} and Chan, {Wing P.}",

note = "Funding Information: This study were supported by an educational grant from the Taiwanese Osteoporosis Association , MOST108-2314-B-006-043-MY2 and research grant from the National Cheng Kung University Hospital ( NCKUH-10709012 , NCKUH-10909042 and NCKUSCMH10817 ). The authors thank Ian R. Reid for his valuable comments in study design. Publisher Copyright: {\textcopyright} 2020 The Author(s) Copyright: Copyright 2020 Elsevier B.V., All rights reserved.",

year = "2020",

month = dec,

doi = "10.1016/j.bonr.2020.100729",

language = "English",

volume = "13",

journal = "Bone Reports",

issn = "2352-1872",

publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - Pharmacologic intervention for prevention of fractures in osteopenic and osteoporotic postmenopausal women

T2 - Systemic review and meta-analysis

AU - Wu, Chih Hsing

AU - Hung, Wei Chieh

AU - Chang, Ing Lin

AU - Tsai, Tsung Ting

AU - Chang, Yin Fan

AU - McCloskey, Eugene V.

AU - Watts, Nelson B.

AU - McClung, Michael R.

AU - Huang, Chun Feng

AU - Chen, Chung Hwan

AU - Wu, Kun Ling

AU - Tsai, Keh Sung

AU - Chan, Ding Cheng

AU - Chen, Jung Fu

AU - Tu, Shih Te

AU - Hwang, Jawl Shan

AU - Xia, Weibo

AU - Matsumoto, Toshio

AU - Chung, Yoon Sok

AU - Cooper, Cyrus

AU - Kanis, John A.

AU - Yang, Rong Sen

AU - Chan, Wing P.

N1 - Funding Information: This study were supported by an educational grant from the Taiwanese Osteoporosis Association , MOST108-2314-B-006-043-MY2 and research grant from the National Cheng Kung University Hospital ( NCKUH-10709012 , NCKUH-10909042 and NCKUSCMH10817 ). The authors thank Ian R. Reid for his valuable comments in study design. Publisher Copyright: © 2020 The Author(s) Copyright: Copyright 2020 Elsevier B.V., All rights reserved.

PY - 2020/12

Y1 - 2020/12

N2 - 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.

AB - 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.

KW - Fracture

KW - Low bone mass

KW - Osteopenia

KW - Osteoporosis

KW - Primary prevention

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DO - 10.1016/j.bonr.2020.100729

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JO - Bone Reports

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M1 - 100729

ER -

Pharmacologic intervention for prevention of fractures in osteopenic and osteoporotic postmenopausal women: Systemic review and meta-analysis

Abstract

Keywords

ASJC Scopus subject areas

UN SDGs

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