Pharmacological Management of Postmenopausal Osteoporosis: a Level I Evidence Based - Expert Opinion

ABSTRACT

Objectives: Postmenopausal osteoporosis carries a high risk of fractures, which decrease quality of life and are associated with high morbidity, mortality, and economic burden. The best pharmacological treatment options to manage and prevent osteoporotic fractures remain still unclear. The present study investigated the efficacy and safety of the most commonly employed drugs in the management of postmenopausal osteoporosis.

Methods: Only RCTs comparing different drugs for the management of postmenopausal osteoporosis were included. Data from 76 RCTs (205,011 patients) were collected. The mean follow-up was 27.6 ± 14.9 months.

Results: Denosumab reported the lowest rate of non-vertebral fractures (LOR −1.57), Romosozumab the lowest rate of vertebral fractures (LOR 1.99), and Ibandronate the lowest rate of hip fractures (LOR0.18). Serious adverse events resulted in the lowest in the Raloxifene group (LOR 3.11), while those leading to study discontinuation were lowest in the Romosozumab cohort (LOR 2.65).

Conclusions: Denosumab resulted in most effective, particularly in reducing the occurrence of non-vertebral fractures. Romosozumab and Ibandronate resulted best to prevent, respectively, vertebral fractures and hip fractures. Adverse events leading to study discontinuation were less frequent in the Romosozumab and Denosumab groups, while Raloxifene and Alendronate showed a lower incidence of serious adverse events overall.

Level of evidence: I, Bayesian network meta-analysis of RCTs.

KEYWORDS:

• Osteoporosis
• fractures
• postmenopausal
• drugs

Article Highlights

• Postmenopausal osteoporosis is a chronic, progressive condition, with a high risk of pathologic fractures. Osteoporotic-related fractures decrease quality of life and are associated with high morbidity, mortality, and economic burden.

• Bisphosphonates are commonly used as first-line therapy. However, other compounds, such as monoclonal antibodies, analogs of parathormone, and selective estrogen receptor modulators are increasingly being employed.

• Denosumab resulted were most effective, particularly in reducing the occurrence of non-vertebral fractures. Romosozumab and Ibandronate resulted in the best compounds to prevent, respectively, vertebral fractures, and hip fractures.

• Adverse events leading to study discontinuation were less frequent in the Romosozumab and Denosumab groups, while Raloxifene and Alendronate showed a lower incidence of serious adverse events overall.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants, or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.