Hip and non-spine fracture risk reductions differ among antiresorptive agents: evidence from randomised controlled trials

Summary A number of antiresorptive agents reduce the risk of vertebral fractures, but few have shown consistent effects on hip and other non‐spine fractures. Meta‐analysis provides a more precise estimate than individual trials when results are consistent across pooled trials. Earlier meta‐analyses summarised the results for vertebral and non‐spine fractures. New data have emerged for hormone therapy (HT), alendronate (ALN), risedronate (RIS) and ibandronate (IBN). We surveyed recent reports of randomised, placebo‐controlled trials with non‐spine and/or hip fracture data, and used meta‐analysis where appropriate to test for heterogeneity and derive pooled estimates. The magnitude of effect on hip fracture appears to be similar to that for non‐spine fracture for each drug, but differs among drugs. Based on the current data, ALN reduces the risk of hip and non‐spine fracture by 49–55%, HT by 25–36% and RIS by 26–27%. There is insufficient and/or inconsistent evidence of an effect on these fractures for IBN, calcitonin and raloxifene.