Meta-Analyses of Therapies for Postmenopausal Osteoporosis

The availability of new therapeutic agents has made clinical decision-making in osteoporosis more complex. Because individual clinicians cannot systematically collect and assimilate all the evidence bearing on the efficacy of osteoporosis therapies, they require summaries for evidence-based decision-making. Systematic reviews using rigorous methods provide an unbiased, comprehensive summary of the available evidence, and meta-analysis provides the most precise possible estimate of the treatment effect. The articles in this series represent systematic reviews of a number of osteoporosis therapies: calcium and vitamin D, the bisphosphonates alendronate and risedronate, hormone replacement therapy, raloxifene, and calcitonin. We used state-of-the-art methodology to provide the most clear and accurate characterization of the effectiveness of these therapies. These include explicit eligibility criteria; a comprehensive search; validity assessment that focused on concealment of randomization, blinding, and completeness of follow-up; and sophisticated analytic methods. In addition, two or more reviewers made independent, reproducible decisions regarding study inclusion and assessments of study validity. Only alendronate and risedronate reduced the risk of both nonvertebral and vertebral fractures. Other agents that reduced vertebral fracture included raloxifene, etidronate, vitamin D, and calcitonin. Clinicians should consider these results when selecting antiosteoporosis therapies for postmenopausal women.