IX: Summary of Meta-Analyses of Therapies for Postmenopausal Osteoporosis

Abstract

This section summarizes the results of the seven systematic reviews of osteoporosis therapies published in this series [calcium, vitamin D, hormone replacement therapy (HRT), alendronate, risedronate, raloxifene, and calcitonin] and systematic reviews of etidronate and fluoride we have published elsewhere. We highlight the methodological strengths and weaknesses of the individual studies, and summarize the effects of treatments on the risk of vertebral and nonvertebral fractures and on bone density, including effects in different patient subgroups. We provide an estimate of the expected impact of antiosteoporosis interventions in prevention and treatment populations using the number needed to treat (NNT) as a reference. In addition to the evidence, judgements about the relative weight that one places on weaker and stronger evidence, attitudes toward uncertainty, circumstances of patients’ and societal values or preferences will, and should, play an important role in decision-making regarding anti-osteoporosis therapy. POSTMENOPAUSAL OSTEOPOROSIS IS a major public health problem (1). Thirty to fifty percent of American women will, in the course of their lifetime, suffer a clinical fracture and the associated morbidity. Estrogen deficiency is a key factor in the pathogenesis of postmenopausal osteoporosis. Osteoporotic fractures are associated with substantial suffering; in particular, both vertebral and hip fractures are associated with increased mortality and diminished quality of life (1, 2). The prevalence of vertebral and hip fractures increases with advanced age. As a larger proportion of women survive into old age, osteoporotic fractures constitute a progressively greater burden of both illness and resource demand.