Meta-analysis: osteoporosis drugs fail to reduce mortality

  • Cummings SR & al.
  • JAMA Intern Med
  • 19 Aug 2019

  • International Clinical Digest
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Takeaway

  • A meta-analysis of 38 randomised controlled trials finds no association between drug therapy for osteoporosis and lower overall mortality.

Why this matters

  • Observational studies have supported an association with reduced mortality, but are not as methodologically strong and may not have adequately controlled for confounders.
  • Authors recommend that osteoporosis therapy, especially bisphosphonates, be reserved for reducing fracture risk.

Study design

  • Meta-analysis of 38 randomised trials with a duration ≥1 year (n=101,642 participants) after a search of Science Direct, MEDLINE, Embase, and Cochrane Library.
  • Funding: None disclosed.

Key results

  • No association between osteoporosis drug therapy (vs placebo) and overall mortality (risk ratio [RR], 0.98; 95% CI, 0.91-1.05), with no evidence of heterogeneity (I2=0%).
  • Findings supported in subgroup analysis:
    • Bisphosphonates (RR, 0.95; 95% CI, 0.86-1.04).
    • Zoledronate (RR, 0.88; 95% CI, 0.68-1.13; I2=48.2%).
    • Alendronate (RR, 1.00, 95%, CI 0.71-1.40)
  • No association observed even with treatment duration ≥3 years (RR, 0.97; 95% CI, 0.88-1.08).

Limitations

  • High heterogeneity in zoledronate subanalysis.
  • No trials of odanacatib have been published beyond abstract results.