Harvard Women's Health Watch

In Brief: Many drugs prevent fractures, but none is best, study finds

In Brief

Many drugs prevent fractures, but none is best, study finds

Although many medications help prevent osteoporotic fractures, there's not enough evidence to say whether any one of them is superior. That's the conclusion of a systematic review by researchers at the Southern California/RAND Evidence-based Practice Center. The review — funded by the Agency for Healthcare Research and Quality (AHRQ), part of the U.S. Department of Health and Human Services — included 76 randomized trials and 24 meta-analyses (research that combines and analyzes the results of several other studies) evaluating bisphosphonates, calcitonin, calcium, estrogen, parathyroid hormone, selective estrogen receptor modulators (SERMs), testosterone for men, and vitamin D, in people with low bone density or osteoporosis. Findings were published in the Feb. 5, 2008, issue of Annals of Internal Medicine.

The report finds that spinal fractures are prevented by the bisphosphonates alendronate (Fosamax), etidronate (Didronel), ibandronate (Boniva), risedronate (Actonel), and zoledronic acid (Zometa; Reclast is now also approved) and also by calcitonin, estrogen, parathyroid hormone (Forteo), and the SERM raloxifene (Evista). Fosamax, Actonel, Zometa, estrogen, and Forteo prevent hip and other nonspinal fractures. Vitamin D can help, but the effects vary with dose, type, and other factors for both spine and hip fractures. The researchers conclude that no single agent has emerged as best, partly because comparative studies haven't lasted long enough or included an adequate number of subjects.

What about calcium? The AHRQ study found little evidence that it prevents osteoporotic fractures in postmenopausal women. But the researchers note that patients often fail to keep taking calcium at the recommended dose. One randomized trial showed a lowered fracture risk among subjects who stuck with the prescribed calcium regimen. Similarly, in the Women's Health Initiative, only the women who took the full intended dose of calcium (1,000 milligrams) and vitamin D (400 IU) had fewer hip fractures.

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