Efficacy of alendronate and risedronate on bone mineral density in men with osteoporosis or osteopenia: a meta-analysis

Abstract

Specific Aims: To determine efficacy of alendronate (ALN) and risedronate (RIS) for treatment of osteoporosis and osteopenia in men. Methods: Literature search was primarily via PubMed. Inclusion criteria were: randomized controlled trials or observational studies assessing treatment of osteoporosis in men, either of primary or secondary etiology. Exclusion criteria were: minority population with baseline osteoporosis, inclusion of women, lack of control group. Primary outcomes were bone mineral density (BMD) of femoral neck (FN) and lumbar spine (LS); secondary outcomes were vertebral or non-vertebral fractures incidence. Data were synthesized using a random effects meta-analysis. Main Results: Eleven ALN and six RIS studies were included; most provided LS and FN data, but trials longer than 1-year were infrequent (ALN 3, RIS 4) as were fracture data (ALN 4, RIS 3). For both FN and LS BMD, both drugs showed significant treatment effects at one and two-years (p<0.001). For FN BMD, 2-year treatment effects were ALN: SDM= 0.638, p<0.001; RIS: SDM= 0.391, p<0.001; heterogeneity was insignificant (p> 0.05). For LS BMD, treatment effects were: 2-year ALN: SDM= 1.206, p<0.001; 1-year RIS: SDM= 0.0.574; p<0.001; heterogeneity was insignificant (p>0.05). For fracture, both drugs showed significant treatment effects at vertebral sites: ALN: OR 0.450, p<0.05; RIS: OR 0.423, p=0.001; heterogeneity was insignificant (p>0.05). RIS also showed a promising effect at non-vertebral sites (p<0.05), however only two studies provided data at this site. Conclusion: Both ALN and RIS are effective to increase BMD and decrease vertebral fracture occurrence in men with osteoporosis or osteopenia.