Effectiveness of anti-osteoporotic drugs to prevent secondary fragility fractures: systematic review and meta-analysis

T. Saito, J. M. Sterbenz, S. Malay, L. Zhong, M. P. MacEachern, K. C. Chung

Research output: Contribution to journalReview articlepeer-review

67 Citations (Scopus)


Patients with osteoporotic fractures have an increased risk for secondary fractures. However, a rigorous study that assesses the effectiveness of individual osteoporotic drugs in preventing subsequent fractures is lacking. The purpose of this review was to analyze the effectiveness of anti-osteoporotic drugs in preventing secondary fractures. We searched for randomized controlled trials that showed the incidence of secondary fractures while using anti-osteoporotic drugs (bisphosphonates, selective estrogen receptor modulators, parathyroid hormone (PTH), or calcitonin) in MEDLINE, Embase.com, and Cochrane Central Register databases. We estimated risk ratios (RR) and numbers needed to treat (NNT) to prevent secondary fractures. Twenty-six studies met our eligibility criteria. There was a significant reduction in RR (0.38–0.77) after the use of anti-osteoporotic drugs for secondary vertebral fractures. Bisphosphonates and PTH significantly reduced the risk of a secondary non-vertebral fracture (RR 0.59 and 0.64). PTH needed the fewest number of patients to be treated to prevent a secondary vertebral fracture (NNT: 56). Our study demonstrated the effectiveness of anti-osteoporotic agents included in our systematic review in preventing secondary vertebral fractures. Bisphosphonates and PTH were most effective in preventing non-vertebral fractures. We suggest that clinicians should prescribe these drugs to prevent secondary vertebral/non-vertebral fractures.

Original languageEnglish
Pages (from-to)3289-3300
Number of pages12
JournalOsteoporosis International
Issue number12
Publication statusPublished - Dec 1 2017


  • Bisphosphonates
  • Drug therapy
  • Fragility fracture
  • Osteoporosis
  • Parathyroid hormone
  • Secondary fractures
  • Selective estrogen receptor modulators

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism


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