Clinical efficacy and safety of drug interventions for primary and secondary prevention of osteoporotic fractures in postmenopausal women: Network meta-analysis followed by factor and cluster analysis
We aimed to evaluate the comparative efficacy and safety of drugs respectively for primary prevention and secondary prevention of osteoporotic fractures in postmenopausal women (PMW), and to further identify the optimal intervention(s) respectively for the two groups when efficacy and safety both co...
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| Veröffentlicht in: | PloS one 2020-06, Vol.15 (6), p.e0234123 |
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| creator | Wen, Fei Du, Hongheng Ding, Liangliang Hu, Jinxi Huang, Zifeng Huang, Hua Li, Kaikai Mo, Yuxia Kuang, Anyin |
| description | We aimed to evaluate the comparative efficacy and safety of drugs respectively for primary prevention and secondary prevention of osteoporotic fractures in postmenopausal women (PMW), and to further identify the optimal intervention(s) respectively for the two groups when efficacy and safety both considered. We searched three databases. Bayesian network meta-analyses were conducted for two efficacy outcomes (vertebral fractures and nonvertebral fractures) and two safety outcomes (tolerability and acceptability) respectively in primary prevention group and secondary prevention group. We synthesized hazard ratios (HRs) and 95% confidence intervals (CIs) for nonvertebral fractures, and risk ratios (RRs) for three others. Factor and cluster analyses on surface under the cumulative ranking curve (SUCRA) values were conducted to identify the best intervention(s) with efficacy and safety both considered. The study protocol has been registered in PROSPERO. We included 57 randomized trials involving fifteen anti-osteoporotic interventions and 106320 PMW. For primary prevention, only zoledronate (once per 18 months) reduced both vertebral (RR 0.46, 95% CI 0.28-0.74) and nonvertebral (HR 0.66, 95% CI 0.51-0.85) fractures. For secondary prevention, abaloparatide, alendronate, denosumab, lasofoxifene, risedronate, romosozumab, teriparatide, and zoledronate (once per 12 months) reduced both vertebral (RRs: from 0.17 to 0.62) and nonvertebral (HRs: from 0.54 to 0.81) fractures. PTH (1-84) and abaloparatide increased withdrawal risk. Romosozumab, teriparatide, denosumab and risedronate, with the greatest composite scores, constituted the optimal cluster having both superior efficacy and superior safety. Zoledronate used at 5 mg per 18 months, with the similar safety as placebo, is the only drug intervention which has been shown to significantly reduce both vertebral and nonvertebral fractures for primary prevention of osteoporotic fractures in PMW; while romosozumab, teriparatide, denosumab, and risedronate are the optimal treatments for secondary prevention when efficacy and safety both considered. A limitation is that safety outcomes failed to consider the severity of adverse effects. |
| doi_str_mv | 10.1371/journal.pone.0234123 |
| format | Article |
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We searched three databases. Bayesian network meta-analyses were conducted for two efficacy outcomes (vertebral fractures and nonvertebral fractures) and two safety outcomes (tolerability and acceptability) respectively in primary prevention group and secondary prevention group. We synthesized hazard ratios (HRs) and 95% confidence intervals (CIs) for nonvertebral fractures, and risk ratios (RRs) for three others. Factor and cluster analyses on surface under the cumulative ranking curve (SUCRA) values were conducted to identify the best intervention(s) with efficacy and safety both considered. The study protocol has been registered in PROSPERO. We included 57 randomized trials involving fifteen anti-osteoporotic interventions and 106320 PMW. For primary prevention, only zoledronate (once per 18 months) reduced both vertebral (RR 0.46, 95% CI 0.28-0.74) and nonvertebral (HR 0.66, 95% CI 0.51-0.85) fractures. For secondary prevention, abaloparatide, alendronate, denosumab, lasofoxifene, risedronate, romosozumab, teriparatide, and zoledronate (once per 12 months) reduced both vertebral (RRs: from 0.17 to 0.62) and nonvertebral (HRs: from 0.54 to 0.81) fractures. PTH (1-84) and abaloparatide increased withdrawal risk. Romosozumab, teriparatide, denosumab and risedronate, with the greatest composite scores, constituted the optimal cluster having both superior efficacy and superior safety. Zoledronate used at 5 mg per 18 months, with the similar safety as placebo, is the only drug intervention which has been shown to significantly reduce both vertebral and nonvertebral fractures for primary prevention of osteoporotic fractures in PMW; while romosozumab, teriparatide, denosumab, and risedronate are the optimal treatments for secondary prevention when efficacy and safety both considered. A limitation is that safety outcomes failed to consider the severity of adverse effects.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0234123</identifier><identifier>PMID: 32492050</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Abaloparatide ; Alendronate ; Alendronic acid ; Bayes Theorem ; Bayesian analysis ; Bazedoxifene ; Biology and Life Sciences ; Biomedical materials ; Bisphosphonates ; Bone density ; Bone Density Conservation Agents - adverse effects ; Bone Density Conservation Agents - therapeutic use ; Bone disorder agents ; Clinical trials ; Cluster Analysis ; Computer and Information Sciences ; Confidence intervals ; Databases, Factual ; Demographic aspects ; Denosumab ; Dose-Response Relationship, Drug ; Drug Administration Schedule ; Drug therapy ; Drugs ; Female ; Fractures ; Fractures (Injuries) ; Hospitals ; Humans ; Intervention ; Medicine and Health Sciences ; Meta-analysis ; Monoclonal antibodies ; Orthopedics ; Osteoporosis ; Osteoporotic Fractures - pathology ; Osteoporotic Fractures - prevention & control ; Parathyroid hormone ; Parathyroid hormones ; Physical Sciences ; Post-menopause ; Postmenopausal women ; Postmenopause ; Prevention ; Proportional Hazards Models ; Research and Analysis Methods ; Risedronic acid ; Risk ; Safety ; Secondary Prevention ; Studies ; Treatment Outcome ; Vertebrae ; Women ; Zoledronate ; Zoledronic acid ; Zoledronic Acid - adverse effects ; Zoledronic Acid - therapeutic use</subject><ispartof>PloS one, 2020-06, Vol.15 (6), p.e0234123</ispartof><rights>COPYRIGHT 2020 Public Library of Science</rights><rights>2020 Wen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2020 Wen et al 2020 Wen et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c622t-c3c44fc90b3a8749538443bcdb6bd065c1de6e4889fcb86cc2c0e16ff348187d3</citedby><cites>FETCH-LOGICAL-c622t-c3c44fc90b3a8749538443bcdb6bd065c1de6e4889fcb86cc2c0e16ff348187d3</cites><orcidid>0000-0003-0374-2539</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7269244/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7269244/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2102,2928,23866,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32492050$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Isales, Carlos M.</contributor><creatorcontrib>Wen, Fei</creatorcontrib><creatorcontrib>Du, Hongheng</creatorcontrib><creatorcontrib>Ding, Liangliang</creatorcontrib><creatorcontrib>Hu, Jinxi</creatorcontrib><creatorcontrib>Huang, Zifeng</creatorcontrib><creatorcontrib>Huang, Hua</creatorcontrib><creatorcontrib>Li, Kaikai</creatorcontrib><creatorcontrib>Mo, Yuxia</creatorcontrib><creatorcontrib>Kuang, Anyin</creatorcontrib><title>Clinical efficacy and safety of drug interventions for primary and secondary prevention of osteoporotic fractures in postmenopausal women: Network meta-analysis followed by factor and cluster analysis</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>We aimed to evaluate the comparative efficacy and safety of drugs respectively for primary prevention and secondary prevention of osteoporotic fractures in postmenopausal women (PMW), and to further identify the optimal intervention(s) respectively for the two groups when efficacy and safety both considered. 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For secondary prevention, abaloparatide, alendronate, denosumab, lasofoxifene, risedronate, romosozumab, teriparatide, and zoledronate (once per 12 months) reduced both vertebral (RRs: from 0.17 to 0.62) and nonvertebral (HRs: from 0.54 to 0.81) fractures. PTH (1-84) and abaloparatide increased withdrawal risk. Romosozumab, teriparatide, denosumab and risedronate, with the greatest composite scores, constituted the optimal cluster having both superior efficacy and superior safety. Zoledronate used at 5 mg per 18 months, with the similar safety as placebo, is the only drug intervention which has been shown to significantly reduce both vertebral and nonvertebral fractures for primary prevention of osteoporotic fractures in PMW; while romosozumab, teriparatide, denosumab, and risedronate are the optimal treatments for secondary prevention when efficacy and safety both considered. 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Academic</collection><collection>ProQuest Engineering Collection</collection><collection>ProQuest Biological Science Collection</collection><collection>Agricultural Science Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Biological Science Database</collection><collection>Engineering Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Advanced Technologies & Aerospace Database</collection><collection>ProQuest Advanced Technologies & Aerospace Collection</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Environmental Science Database</collection><collection>Materials Science Collection</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>Engineering Collection</collection><collection>Environmental Science Collection</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Wen, Fei</au><au>Du, Hongheng</au><au>Ding, Liangliang</au><au>Hu, Jinxi</au><au>Huang, Zifeng</au><au>Huang, Hua</au><au>Li, Kaikai</au><au>Mo, Yuxia</au><au>Kuang, Anyin</au><au>Isales, Carlos M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Clinical efficacy and safety of drug interventions for primary and secondary prevention of osteoporotic fractures in postmenopausal women: Network meta-analysis followed by factor and cluster analysis</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2020-06-03</date><risdate>2020</risdate><volume>15</volume><issue>6</issue><spage>e0234123</spage><pages>e0234123-</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>We aimed to evaluate the comparative efficacy and safety of drugs respectively for primary prevention and secondary prevention of osteoporotic fractures in postmenopausal women (PMW), and to further identify the optimal intervention(s) respectively for the two groups when efficacy and safety both considered. We searched three databases. Bayesian network meta-analyses were conducted for two efficacy outcomes (vertebral fractures and nonvertebral fractures) and two safety outcomes (tolerability and acceptability) respectively in primary prevention group and secondary prevention group. We synthesized hazard ratios (HRs) and 95% confidence intervals (CIs) for nonvertebral fractures, and risk ratios (RRs) for three others. Factor and cluster analyses on surface under the cumulative ranking curve (SUCRA) values were conducted to identify the best intervention(s) with efficacy and safety both considered. The study protocol has been registered in PROSPERO. We included 57 randomized trials involving fifteen anti-osteoporotic interventions and 106320 PMW. For primary prevention, only zoledronate (once per 18 months) reduced both vertebral (RR 0.46, 95% CI 0.28-0.74) and nonvertebral (HR 0.66, 95% CI 0.51-0.85) fractures. For secondary prevention, abaloparatide, alendronate, denosumab, lasofoxifene, risedronate, romosozumab, teriparatide, and zoledronate (once per 12 months) reduced both vertebral (RRs: from 0.17 to 0.62) and nonvertebral (HRs: from 0.54 to 0.81) fractures. PTH (1-84) and abaloparatide increased withdrawal risk. Romosozumab, teriparatide, denosumab and risedronate, with the greatest composite scores, constituted the optimal cluster having both superior efficacy and superior safety. Zoledronate used at 5 mg per 18 months, with the similar safety as placebo, is the only drug intervention which has been shown to significantly reduce both vertebral and nonvertebral fractures for primary prevention of osteoporotic fractures in PMW; while romosozumab, teriparatide, denosumab, and risedronate are the optimal treatments for secondary prevention when efficacy and safety both considered. A limitation is that safety outcomes failed to consider the severity of adverse effects.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>32492050</pmid><doi>10.1371/journal.pone.0234123</doi><tpages>e0234123</tpages><orcidid>https://orcid.org/0000-0003-0374-2539</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2020-06, Vol.15 (6), p.e0234123 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_2409181604 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Public Library of Science (PLoS); PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Abaloparatide Alendronate Alendronic acid Bayes Theorem Bayesian analysis Bazedoxifene Biology and Life Sciences Biomedical materials Bisphosphonates Bone density Bone Density Conservation Agents - adverse effects Bone Density Conservation Agents - therapeutic use Bone disorder agents Clinical trials Cluster Analysis Computer and Information Sciences Confidence intervals Databases, Factual Demographic aspects Denosumab Dose-Response Relationship, Drug Drug Administration Schedule Drug therapy Drugs Female Fractures Fractures (Injuries) Hospitals Humans Intervention Medicine and Health Sciences Meta-analysis Monoclonal antibodies Orthopedics Osteoporosis Osteoporotic Fractures - pathology Osteoporotic Fractures - prevention & control Parathyroid hormone Parathyroid hormones Physical Sciences Post-menopause Postmenopausal women Postmenopause Prevention Proportional Hazards Models Research and Analysis Methods Risedronic acid Risk Safety Secondary Prevention Studies Treatment Outcome Vertebrae Women Zoledronate Zoledronic acid Zoledronic Acid - adverse effects Zoledronic Acid - therapeutic use |
| title | Clinical efficacy and safety of drug interventions for primary and secondary prevention of osteoporotic fractures in postmenopausal women: Network meta-analysis followed by factor and cluster analysis |
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