A systematic review 1 including 13 RCTs with a total of 1 711 subjects was abstracted in DARE.
Lumbar spine:
The mean changes in bone mineral density (BMD) at the lumbar spine ranged from -0.137 to 4.9% in the treatment groups, and from 0.98 to 3.7% in the control groups. Three of the 13 studies (23%) did not show a significant benefit at the lumbar spine when compared with the control group, although 2 of these studies used unusual doses of bisphosphonate.
Femoral neck:
The changes in BMD at the femoral neck ranged from 1.28 to 3.6% in the treatment groups, and from 3.6 to 3.64% in the control groups. Nine of the 13 studies (69%) did not show a statistically-significant difference between the treatment and control groups at the femoral neck.
Femoral trochanter:
The changes in BMD at the femoral trochanter ranged from -1.35 to 2.7% in the treatment groups, and from 1.5 to 3.06% in the control groups. Six of the 10 studies reporting data at the femoral trochanter showed that the treatment group was not significantly better than the control group.
Fracture risk:
In one study, a 10.1% reduction in vertebral fractures was found in patients receiving risedronate (2.5 or 5 mg) at 12 months. When these results were pooled with another trial, it was found that 5.0 mg risedronate statistically decreased the incidence of vertebral fractures at 1 year (16.2 versus 5.4%).
Two studies found borderline significance in the fracture rate when postmenopausal women were analysed separately. The use of etidronate and alendronate led to an absolute risk reduction of 18.7% and 8.6%, respectively.
Comment: The quality of evidence is downgraded by inconsistency (variability in results across studies).
Primary/Secondary Keywords