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Research

Fracture risk reduction and safety by osteoporosis treatment compared with placebo or active comparator in postmenopausal women: systematic review, network meta-analysis, and meta-regression analysis of randomised clinical trials

BMJ 2023; 381 doi: https://doi.org/10.1136/bmj-2021-068033 (Published 02 May 2023) Cite this as: BMJ 2023;381:e068033

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Re: Fracture risk reduction and safety by osteoporosis treatment compared with placebo or active comparator in postmenopausal women: systematic review, network meta-analysis, and meta-regression analysis of randomised clinical trials

Dear Editor

When we evaluate a patient to calculate the risk of fragility fractures, we use FRAX and NOGG to indicate the treatment. These tools assess the risk of hip fractures and osteoporotic major fractures. This article showed no differences for hip fractures to treat with SERM or placebo and, more intriguing, no diffrences for major osteoporotic fractures to treat with denosumab and placebo as well as SERM and placebo.

More expensive drugs such as Rosomumab, PTHR and Denosumab (and remembering that the latter drugs depend on strict adherence to treatment and more problematic routes of administration) were generally not more efficient than oral bisphonates.

These findings are important in real life, where costs and the patient adherence are decisive factors when indicating treatment, especially in populations with difficulties in terms of economic resources and access to health care.

Competing interests: No competing interests

05 May 2023
Henrique Carrico da Silva
Rheumatologist
School of Medicine, University of Sao Paulo-Hospital das Clinicas AND Federal University of Sao Paulo
Av Dr Arnaldo 255-São Paulo -Rheumatology Ambulatorial Service
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