Prevention of osteoporotic fractures
Determining the clinical and cost-effectiveness of alterative bisphosphonates compared to alendronate
Funder: National Institute for Health Research – Health Technology Assessment Programme
The project: Osteoporosis is a common condition affecting over 3 million people in the UK, which leads to weakening of the bones, making them fragile and more likely to fracture. Oral alendronate is recommended as the first line bisphosphonate treatment for treating osteoporosis in adults in England and Wales. However, long term adherence is poor. Alternative bisphosphonates are available. This project aims to determine the clinical and cost-effectiveness of alterative bisphosphonates compared to alendronate at preventing fractures through conducting an updated network meta-analysis of the effectiveness of alternative bisphosphonates and a systematic review of treatment compliance and long-term adherence.
In the first review we identified 68 trials (47,007 participants), which found that all treatments had beneficial effects in preventing fractures and increasing bone mass density compared to placebo. Zoledronate was the most effective treatment for vertebral and hip fractures and resulted in largest increases in bone mass density. Zoledronate and risedronate were equally the most effective for non-vertebral fractures. Treatment effects in preventing vertebral fractures were found to be stronger in people with osteoporosis compared to placebo. The second review included 59 trials and 43 observational studies (2,656,659 participants) assessing the probability of adherence to bisphosphonate treatment. Persistence was found to decrease after 12 months; however, zolendronate users were the least likely to discontinue their treatment over time compared to other treatments. Additionally, higher rates of compliance were seen in those receiving intravenous treatments
Zolendronate could be considered as a first-line option for people at increased risk of fragility fractures due to its comparative effectiveness and higher levels of adherence among bisphosphonate users
For more information contact Honorary Professor Opinder Sahota at opinder.sahota@nuh.nhs.uk
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