AHRQ Effective Health Care Program - Research Reviews

Comparative Effectiveness of Treatments To Prevent Fractures in Men and Women With Low Bone Density or Osteoporosis

Background
Osteoporosis is a systemic skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fracture. The clinical complications of osteoporosis include fractures, disability, and chronic pain. Approximately 44 million people in the United States are affected by osteoporosis or low bone density. It is especially common in postmenopausal women.

This report summarizes the available evidence comparing the efficacy and safety of agents used to prevent or treat low bone density, including osteoporosis. The following questions are addressed in this report:

* Key Question 1. What are the comparative benefits in fracture reduction among and also within the following treatments for low bone density:

- Bisphosphonate medications, specifically alendronate, risedronate, etidronate, ibandronate, pamidronate, and zoledronic acid.
- Calcitonin.
- Calcium.
- Estrogen for women.
- Parathyroid hormone (PTH).
S- elective estrogen receptor modulators (SERMs), specifically raloxifene and tamoxifen.
- Testosterone for men.
- Vitamin D.
- Combinations of above.
- Exercise in comparison to above agents.

** Key Question 2. How does fracture reduction resulting from treatments vary between individuals with different risks for fracture as determined by bone mineral density (borderline/low/severe), prior fractures (prevention vs. treatment), age, gender, glucocorticoid use, and other factors (e.g., community dwelling vs. institutionalized, vitamin D deficient vs. not)?

*** Key Question 3. What are the adherence and persistence to medications for the treatment and prevention of osteoporosis, the factors that affect adherence and persistence, and the effects of adherence and persistence on the risk of fractures?

**** Key Question 4. What are the short- and long-term harms (adverse effects) of the above therapies, and do these vary by any specific subpopulations?

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AHRQ Effective Health Care Program - Research Reviews