• Carolyn J Crandall, Sydne J Newberry, Allison Diamant, Yee-Wei Lim, Walid F Gellad, Marika J Booth, Aneesa Motala, and Paul G Shekelle.
• Ann. Intern. Med. 2014 Nov 18; 161 (10): 711-23.

BackgroundOsteoporosis is a major contributor to the propensity to fracture among older adults, and various pharmaceuticals are available to treat it.PurposeTo update a review about the benefits and harms of pharmacologic treatments used to prevent fractures in adults at risk.Data SourcesMultiple computerized databases were searched between 2 January 2005 and 4 March 2014 for English-language studies.Study SelectionTrials, observational studies, and systematic reviews.Data ExtractionDuplicate extraction and assessment of data about study characteristics, outcomes, and quality.Data SynthesisFrom 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.LimitationsFew studies have directly compared drugs used to treat osteoporosis. Data in men are very sparse. Costs were not assessed.ConclusionGood-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 SourceAgency for Healthcare Research and Quality and RAND Corporation.

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