Talk to the Veterans Crisis Line now
U.S. flag
An official website of the United States government

VA Health Systems Research

Go to the VA ORD website
Go to the QUERI website

HSR Citation Abstract

Search | Search by Center | Search by Source | Keywords in Title

Comparative effectiveness of pharmacologic treatments to prevent fractures: an updated systematic review.

Crandall CJ, Newberry SJ, Diamant A, Lim YW, Gellad WF, Booth MJ, Motala A, Shekelle PG. Comparative effectiveness of pharmacologic treatments to prevent fractures: an updated systematic review. Annals of internal medicine. 2014 Nov 18; 161(10):711-23.

Dimensions for VA is a web-based tool available to VA staff that enables detailed searches of published research and research projects.

If you have VA-Intranet access, click here for more information

VA staff not currently on the VA network can access Dimensions by registering for an account using their VA email address.
   Search Dimensions for VA for this citation
* Don't have VA-internal network access or a VA email address? Try searching the free-to-the-public version of Dimensions


BACKGROUND: Osteoporosis is a major contributor to the propensity to fracture among older adults, and various pharmaceuticals are available to treat it. PURPOSE: To update a review about the benefits and harms of pharmacologic treatments used to prevent fractures in adults at risk. DATA SOURCES: Multiple computerized databases were searched between 2 January 2005 and 4 March 2014 for English-language studies. STUDY SELECTION: Trials, observational studies, and systematic reviews. DATA EXTRACTION: Duplicate extraction and assessment of data about study characteristics, outcomes, and quality. DATA SYNTHESIS: From more than 52 000 titles screened, 315 articles were included in this update. There is high-strength evidence that bisphosphonates, denosumab, and teriparatide reduce fractures compared with placebo, with relative risk reductions from 0.40 to 0.60 for vertebral fractures and 0.60 to 0.80 for nonvertebral fractures. Raloxifene has been shown in placebo-controlled trials to reduce only vertebral fractures. Since 2007, there is a newly recognized adverse event of bisphosphonate use: atypical subtrochanteric femur fracture. Gastrointestinal side effects, hot flashes, thromboembolic events, and infections vary among drugs. LIMITATIONS: Few studies have directly compared drugs used to treat osteoporosis. Data in men are very sparse. Costs were not assessed. CONCLUSION: Good-quality evidence supports that several medications for bone density in osteoporotic range and/or preexisting hip or vertebral fracture reduce fracture risk. Side effects vary among drugs, and the comparative effectiveness of the drugs is unclear. PRIMARY FUNDING SOURCE: Agency for Healthcare Research and Quality and RAND Corporation.

Questions about the HSR website? Email the Web Team

Any health information on this website is strictly for informational purposes and is not intended as medical advice. It should not be used to diagnose or treat any condition.