Hip and non-spine fracture risk reductions differ among antiresorptive agents: evidence from randomised controlled trials


Uri A. Liberman, MD, PhD, Felsenstein Medical Research Center, Department of Physiology & Pharmacology, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Email: uliberm@post.tau.ac.il


A number of antiresorptive agents reduce the risk of vertebral fractures, but few have shown consistent effects on hip and other non-spine fractures. Meta-analysis provides a more precise estimate than individual trials when results are consistent across pooled trials. Earlier meta-analyses summarised the results for vertebral and non-spine fractures. New data have emerged for hormone therapy (HT), alendronate (ALN), risedronate (RIS) and ibandronate (IBN). We surveyed recent reports of randomised, placebo-controlled trials with non-spine and/or hip fracture data, and used meta-analysis where appropriate to test for heterogeneity and derive pooled estimates. The magnitude of effect on hip fracture appears to be similar to that for non-spine fracture for each drug, but differs among drugs. Based on the current data, ALN reduces the risk of hip and non-spine fracture by 49–55%, HT by 25–36% and RIS by 26–27%. There is insufficient and/or inconsistent evidence of an effect on these fractures for IBN, calcitonin and raloxifene.