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Table 2 Summary of findings of osteoporotic vertebral fracture and non-vertebral fracture

From: Effect of medications on prevention of secondary osteoporotic vertebral compression fracture, non-vertebral fracture, and discontinuation due to adverse events: a meta-analysis of randomized controlled trials

Comparison RR (95% CI) No. of participants (studies) Quality of the evidence
Vertebral fracture
 Antiresorptive medication vs. Control 0.59 (0.53 to 0.65) 21,012 (30 RCTs)
 ZOL vs. Control 0.34 (0.17 to 0.69) 657 (1 RCT) a MODERATE b,
 ALN vs. Control 0.54 (0.43 to 0.68) 2277 (3 RCTs) c HIGH
 RISE vs. Control 0.61 (0.51 to 0.73) 2645 (5 RCTs) d MODERATE e
 Etidronate vs. Control 0.60 (0.39 to 0.92) 618 (7 RCTs) f MODERATE g,
 Ibandronate (sufficient) vs. Control 0.52 (0.38 to 0.71) 2929 (1 RCT) h MODERATE i,
 Ibandronate (insufficient) vs. Control 0.87 (0.69 to 1.11) 2860 (1 RCT) j MODERATE k
 Minodronate vs. Control 0.44 (0.31 to 0.63) 674 (1 RCT) l LOW m
 Pamidronate vs. Control 0.33 (0.13 to 0.84) 90 (1 RCT) n VERY LOW o
 Calcitonin vs. Control 1.02 (0.14 to 7.36) 157 (3 RCTs) p VERY LOW q
 HRT vs. Control 0.86 (0.29 to 2.52) 147 (3 RCTs) r LOW s
 PTH vs. Control 0.32 (0.24 to 0.43) 2632 (4 RCTs) t MODERATE u
 Denosumab vs. Control 0.41 (0.29 to 0.57) 1654 (2 RCTs) v MODERATE w
 RLX vs. Control 0.58 (0.44 to 0.76) 2447 (2 RCTs) x HIGH
 BZA vs. Control 0.66 (0.53 to 0.82) 3857 (1 RCT) y MODERATE z
 ALN vs. Denosumab 0.69 (0.41 to 1.17) 722 (1 RCT) aa LOW bb
 Romosozumab vs. Alendronate 0.64 (0.49 to 0.84) 4093 (1 RCT)cc MODERATEdd
 RISE vs. Etidronate 1.12 (0.69 to 1.81) 433 (1 RCT) ee MODERATE ff
 Ibandronate vs. RISE 1.01 (0.79 to 1.31) 1228 (1 RCT)gg HIGH
 RISE vs. Teriparatide 1.98 (1.44 to 2.70) 2070 (2 RCTs) hh HIGH
 HRT vs. Etidronate 0.63 (0.12 to 3.32) 35 (1 RCT) ii VERY LOW jj
Non-vertebral fracture
 ZOL vs. Control 0.54 (0.32 to 0.91) 661 (1 RCT)kk
 ALN vs. Control 0.81 (0.65 to 1.01) 2027 (1 RCT)ll
 RISE vs. Control 0.71 (0.54 to 0.92) 2836 (4 RCTs)mm
 Etidronate vs. Control 0.95 (0.59 to 1.53) 395 (4 RCTs)nn
 Ibandronate (sufficient) vs. Control 1.10 (0.85 to 1.41) 2929 (1 RCT)oo
 Ibandronate (insufficient) vs. Control (only Hip fracture) 0.59 (0.26 to 1.31) 2860 (1 RCT)pp
 Minodronate vs. Control 0.80 (0.35 to 1.84) 674 (1 RCT)qq
 Pamidronate vs. Control 0.33 (0.04 to 3.10) 100 (1 RCT)rr
 PTH vs. Control 0.53 (0.36 to 0.78) 2454 (3 RCTs)ss
 Denosumab vs. Control 0.45 (0.20 to 1.03) 952 (1 RCT)tt
 Romosozumab vs. ALN 0.74 (0.54 to 1.00) 4093 (1 RCT)uu  
 ALN vs. Dmab 1.49 (0.52 to 4.24) 722 (1 RCT)vv
 Ibandronate vs. RISE 1.12 (0.75 to 1.66) 1134 (1 RCT)gg
 RISE vs. Teriparatide 1.28 (0.94 to 1.73) 2070 (2 RCTs)ww
 HRT vs. Etidronate 0.94 (0.06 to 13.93) 35 (1 RCT)xx
  1. RR Relative Risk, ZOL Zoledronate, ALN Alendronate, RISE Risedronate, PTH Pamidronate, RLX Raloxifene, BZA Bazedoxifene, HRT Hormone replace therapy
  2. aNakamura, 2017 [17]
  3. bStudy limitations: the trial included had unclear risk of performance bias
  4. cLiberman, 1995 [20]; Black, 1996 [18]; Kushida, 2004 [19, 53]
  5. dClemmesen, 1997 [21]; Harris, 1999 [25]; Reginster, 2000 [22]; Fogelman, 2000 [24]; Sorensen, 2003 [23]
  6. eStudy limitations: four trials were included, with unclear risk of selection bias, performance bias and attribution bias
  7. fShiota, 2001 [29]; Montessori, 1997 [28]; Lyritis, 1997 [27]; Watts, 1990 [30]; Harris, 1993 [36]; Wimalawansa, 1998 [41]; Guanabens, 2000 [26]
  8. gStudy limitations: seven trials were included, with unclear to high risk of selection bias, attribution bias, other bias, and performance bias
  9. hChesnut, 2004 [31]
  10. iStudy limitations: one trial was included, with unclear risk of performance bias and attribution bias
  11. jRecker, 2004 Recker, 2004 [32]
  12. kOne trial included, with unclear risk of performance bias and other bias
  13. lMatsumoto, 2009 [33]
  14. mOne trial was included, with unclear risk of performance bias, attribution bias and other source of bias. Imprecision: the number of events was 115 and OIS was not met
  15. nBrumsen, 2002 [35]
  16. oStudy limitation: one trial included, with unclear risk of selection bias. Imprecision (rating down two levels): 20 events and CIs included appreciable benefit
  17. pHodsman, 1997 [38]; Peichl, 1999 [37]; Chesnut, 2005 [39]
  18. qStudy limitation: two trials had unclear to high risk of selection bias, performance bias, attribution bias and other bias. Imprecision (rating down two levels): 15 events and CIs included appreciable benefit and harm
  19. rLufkin, 1992 [42]; Wimalawansa, 1998 [41]; Gutteridge, 2002 [40]
  20. sStudy limitation: two trials had unclear risk of selection bias. Two trials had unclear to high risk of performance bias. Three trials had unclear risk of attribution bias. Three trials had unclear risk of other bias. Imprecision (rating down two levels): 34 events and CIs included appreciable benefit and harm
  21. tNakamura, 2012 [44], Neer, 2001 [43], Greenspan, 2007, Fujita, 2014 [45]
  22. uOne trial had unclear risk of selection bias, performance bias and attribution bias. One trial had high risk of performance bias
  23. vBoonen, 2011 [49]; Nakamura, 2014 [48]
  24. wStudy limitation: two trials had unclear risk of selection bias and performance bias. One trial had had unclear risk of other bias
  25. xEttinger, 1999 [50], Lufkin, 1998 [51]
  26. yPalacios, 2015 [52]
  27. zStudy limitation: one trial had high risk of performance bias and unclear risk of attribution bias and other bias
  28. aaNakamura, 2014 [48]
  29. bbStudy limitation: one study included, with unclear risk of selection bias, performance bias, and other bias. Imprecision: the number of events was 66, and OIS was not met
  30. ccSaag, 2017 [55]
  31. ddStudy limitation: one trial was included, with unclear risk of performance bias
  32. eeKushida, 2004 [53]
  33. ffStudy limitation: one trial was included, with unclear risk of selection bias, attribution bias and other bias
  34. ggNakamura, 2013
  35. hhHadji, 2012 [57]; Kendler, 2017 [58]
  36. iiWimalawansa, 1998 [41]
  37. jjStudy limitation: one trial was included, with unclear risk of performance bias, attribution bias and other bias. Imprecision (rating down two levels): few events and CIs included appreciable benefit and harm
  38. kkNakamura, 2017 [17]
  39. llBlack, 1996 [18]
  40. mmClemmesen, 1997 [21]; Harris, 1999 [25]; Reginster, 2000 [22]; Sorensen, 2003 [23]
  41. nnWatts, 1990 [30]; Lyritis, 1997 [27]; Montessori, 1997 [28]; Guanabens, 2000 [26]
  42. ooChesnut, 2004 [31]
  43. ppRecker, 2004 [32]
  44. qqMatsumoto, 2009 [33]
  45. rrBrumsen, 2002 [35]
  46. ssNakamura, 2012 [44]; Neer, 2001 [43], Fujita, 2014 [45]
  47. ttNakamura, 2014 [48]
  48. uuSaag, 2017 [55]
  49. vvNakamura, 2014 [48]
  50. wwHadji, 2012 [57]; Kendler, 2017 [58]
  51. xxWimalawansa, 1998 [41]