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Evidence summaries

Bisphosphonates for Steroid Induced Osteoporosis

Bisphosphonates reduce the risk of vertebral fractures in people on corticosteroids and appear to prevent and treat corticosteroid-induced bone loss at the lumbar spine and femoral neck in adults. Level of evidence: "A"

A Cochrane review [Abstract] 1 included 27 studies with a total of 3 075 subjects. The aim of the review was to assess the benefits and harms of bisphosphonates for the prevention and treatment of glucocorticoid-induced osteoporosis in adults. Bisphosphonates reduced the risk of vertebral fractures, but made little or no difference in preventing nonvertebral fractures (table T1). They prevented and treated corticosteroid-induced bone loss at both the lumbar spine and femoral neck. There was no statistically significant differences in the occurrence of serious adverse events or withdrawals due to adverse events.

Bisphosphonates (alone or with calcium and/or vitamin D) compared with control (calcium and/or vitamin D and/or placebo) for adults with glucocorticoid-induced osteoporosis

OutcomeRelative efffect (95% CI)Assumed risk - controlCorresponding risk - bisphosphonates (95% CI)NNTB (95% CI)Participants (studies)
Incident vertebral fractures (radiographic follow-up 12-24 months)RR 0.57 (0.35 to 0.91)77 per 100044 per 1000(27 to 70)31 (20 to 145)1 343(12 studies)
Incident nonvertebral fractures(radiographic follow-up 12-24 months)RR 0.79 (0.47 to 1.33)55 per 100042 per 1000(25 to 69)-1 245(9 studies)
Lumbar spine BMD(DEXA follow-up 12 months)-Mean per cent change in BMD was -3.19% (-8.08% to 1.70%)Mean per cent change in BMD was 3.50% higher than control groups (2.90% to 4.10% higher)3 (2 to 3)2 042(23 studies)
Femoral neck BMD(DEXA follow-up 12 months)-Mean per cent change in BMD was -1.59% (-10.49% to 7.31%)Mean per cent change in BMD was 2.06% higher than control groups (1.45% to 2.68% higher)5 (4 to 7)1 665(18 studies)
Serious adverse events(follow-up 12-24 months)RR 0.91 (0.74 to 1.12)162 per 1000147 per 1000(120 to 181)-1 703(15 studies)
Withdrawals due to adverse events (follow-up 12-24 months)RR 1.06 (0.77 to 1.47)73 per 100077 per 1000(56 to 107)-1 790(15 studies)

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    References

    • Allen CS, Yeung JH, Vandermeer B et al. Bisphosphonates for steroid-induced osteoporosis. Cochrane Database Syst Rev 2016;(10):CD001347. [PubMed].

Primary/Secondary Keywords