Efficacy and safety of 18 anti-osteoporotic drugs in the treatment of patients with osteoporosis caused by glucocorticoid: A network meta-analysis of randomized controlled trials

Abstract

Background Glucocorticoids are widely used in a variety of diseases, especially autoimmune diseases and inflammatory diseases, so the incidence of glucocorticoid-induced osteoporosis is high all over the world. Objectives The purpose of this paper is to use the method of network meta-analysis (NMA) to compare the efficacy of anti-osteoporosis drugs directly and indirectly, and to explore the advantages of various anti-osteoporosis drugs based on the current evidence. Methods We searched PubMed, Embase and Cochrane Library for randomized controlled trials (RCTs), of glucocorticoid-induced osteoporosis (GIOP) and compared the efficacy and safety of these drugs by NMA. The risk ratio (RR) and its 95% confidence interval (CI) are used as the influence index of discontinuous data, and the standardized mean difference (SMD) and its 95% CI are used as the influence index of continuous data. The statistical heterogeneity was evaluated by the calculated estimated variance (τ2), and the efficacy and safety of drugs were ranked by the surface under the cumulative ranking curve (SUCRA). The main outcome of this study was the incidence of vertebral fracture after taking several different types of drugs, and the secondary results were the incidence of non-vertebral fracture and adverse events, mean percentage change of lumbar spine (LS) and total hip (TH)bone mineral density (BMD) from baseline to at least 12 months. Results Among the different types of anti-GIOP, teriparatide (SUCRA 95.9%) has the lowest incidence of vertebral fracture; ibandronate (SUCRA 75.2%) has the lowest incidence of non-vertebral fracture; raloxifene (SUCRA 98.5%) has the best effect in increasing LS BMD; denosumab (SUCRA 99.7%) is the best in increasing TH BMD; calcitonin (SUCRA 92.4%) has the lowest incidence of serious adverse events. Conclusions Teriparatide and ibandronate are effective drugs to reduce the risk of vertebral and non-vertebral fractures in patients with GIOP. In addition, long-term use of raloxifene and denosumab can increase the BMD of LS and TH.

Clinical efficacy of denosumab, teriparatide, and oral bisphosphonates in the prevention of glucocorticoid-induced osteoporosis: a systematic review and meta-analysis

“…While oral bisphosphonates are currently the most widely used bone-protective drugs in individuals on GCs, the use of teriparatide and denosumab (if approved) as first-line options in some patients merits further investigation [ 20 ]. Recent meta-analyses have also demonstrated the potential of denosumab and teriparatide as first-line treatments [ 21 , 22 ]. We registered our study with PROSPERO (registration number CRD42022324526).…”

Impact of Alendronate Sodium plus Elcatonin on Postoperative Bone Pain in Patients with Osteoporotic Fractures

“…Reported by Deardorff et al [ 12 ], ALN was preventive against nonvertebral fractures in postmenopausal OP women. Elcatonin (EC), which is also an antibone resorption drug like ALN, mainly inhibits bone resorption by reducing the number of OCs and inhibiting their secretory activity [ 13 ]. Animal experiments show that EC can inhibit the systemic acceleration of bone resorption and bone turnover caused by bone injuries without delaying the healing process of bone defects, which has a good effect on fracture healing [ 14 ].…”

Prevention and Treatment of Glucocorticoid-Induced Osteoporosis in Adults: Consensus Recommendations From the Belgian Bone Club

“…Nevertheless, a Cochrane meta-analysis found high-quality evidence that bisphosphonates (as a class) reduce vertebral fracture risk in GIOP ( 149 ). Furthermore, network meta-analyses of RCTs have found moderate quality evidence that alendronate, risedronate, zoledronate, teriparatide and denosumab reduce fracture risk in GIOP ( 137 , 150 ). For raloxifene and ibandronate, RCTs have reported increased spine and hip BMD ( 151 ) but evidence on fracture risk is insufficient (particularly for the key outcome of vertebral fractures) ( 152 ).…”