{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T15:59:00Z","timestamp":1792511940796,"version":"4.5.0"},"reference-count":47,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2021,7,8]],"date-time":"2021-07-08T00:00:00Z","timestamp":1625702400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Although a range of pharmacological interventions is available, it remains uncertain which treatment for osteoporosis is more effective. This network meta-analysis study aimed to compare different drug efficacy and safety in randomized controlled trials (RCTs) for the treatment of postmenopausal osteoporosis. PubMed, EMBASE, MEDLINE, Clinicaltrial.gov, Cochrane library, Google scholar were searched up to 31 October 2020. Randomized placebo-controlled trials that reported measures of bone mineral density (BMD) percentage change and\/or numbers of adverse events of postmenopausal osteoporosis patients were included. Network meta-analysis was conducted using frequentist approach. Ninety-four RCTs comprising 15,776 postmenopausal osteoporosis females were included in the network meta-analysis. Compared with placebo, most interventions showed increase in BMD change. According to surfaces under the cumulative ranking curves (SUCRAs), strontium ranelate, fluoride, and hormone replacement therapy were most effective in increasing total hip, lumbar spine, and distal radius BMD, respectively. Parathyroid hormone (PTH) was most effective in preventing new hip fracture. When taking into account all anatomic sites, bisphosphonate (BP), monoclonal antibody (mAb), and fluoride have a balanced efficacy in increasing BMD at all sites. Considering both the effectiveness of increasing BMD and preventing hip fracture, mAb, BP, and PTH are more favorable among all interventions. The treatment effects of different medications on BMD percentage change are anatomic site-dependent. After weighing anti-osteoporosis treatment efficacy against risk of complications, BP and mAb are the more favorable interventions to increase BMD at all sites and reduce the risks of hip fracture and death.<\/jats:p>","DOI":"10.3390\/jcm10143043","type":"journal-article","created":{"date-parts":[[2021,7,8]],"date-time":"2021-07-08T10:42:17Z","timestamp":1625740937000},"page":"3043","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":26,"title":["Efficacy and Safety of Postmenopausal Osteoporosis Treatments: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7694-3860","authenticated-orcid":false,"given":"Shih-Yin","family":"Lin","sequence":"first","affiliation":[{"name":"Department of Dentistry, MacKay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Taipei 10449, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min-Chih","family":"Hung","sequence":"additional","affiliation":[{"name":"School of Dentistry, College of Medicine, National Taiwan University, No. 1, Chang-De Street, Taipei 10048, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shih-Fu","family":"Chang","sequence":"additional","affiliation":[{"name":"School of Dentistry, College of Medicine, National Taiwan University, No. 1, Chang-De Street, Taipei 10048, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5797-1885","authenticated-orcid":false,"given":"Fon-Yih","family":"Tsuang","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei 10002, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jenny Zwei-Chieng","family":"Chang","sequence":"additional","affiliation":[{"name":"School of Dentistry, College of Medicine, National Taiwan University, No. 1, Chang-De Street, Taipei 10048, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jui-Sheng","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, College of Medicine, China Medical University, No. 2, Yu-Der Rd., Taichung 40447, Taiwan"},{"name":"Department of Orthopedic Surgery, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei 10002, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,7,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3929","DOI":"10.2147\/DDDT.S179568","article-title":"Effectiveness of thiazides on serum and urinary calcium levels and bone mineral density in patients with osteoporosis: A systematic review and meta-analysis","volume":"12","author":"Cheng","year":"2018","journal-title":"Drug Des. Dev. Ther."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1761","DOI":"10.1016\/S0140-6736(02)08657-9","article-title":"Epidemiology and outcomes of osteoporotic fractures","volume":"359","author":"Cummings","year":"2002","journal-title":"Lancet"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1007\/s10067-018-4370-1","article-title":"Osteoporosis: A clinical and pharmacological update","volume":"38","author":"Vidal","year":"2019","journal-title":"Clin. Rheumatol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"592","DOI":"10.1038\/nrendo.2014.125","article-title":"Fracture mortality: Associations with epidemiology and osteoporosis treatment","volume":"10","author":"Sattui","year":"2014","journal-title":"Nat. Rev. Endocrinol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1007\/s00198-015-3375-8","article-title":"Hip fractures, preceding distal radius fractures and screening for osteoporosis: Should we be screening earlier? A minimum 10-year retrospective cohort study at a single centre","volume":"27","author":"Daruwalla","year":"2016","journal-title":"Osteoporos. Int."},{"key":"ref_6","first-page":"65","article-title":"The clinical epidemiology of male osteoporosis: A review of the recent literature","volume":"7","author":"Willson","year":"2015","journal-title":"Clin. Epidemiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2197","DOI":"10.1007\/s00198-016-3513-y","article-title":"Fracture healing: A consensus report from the International Osteoporosis Foundation Fracture Working Group","volume":"27","author":"Silverman","year":"2016","journal-title":"Osteoporos. Int."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1007\/s00198-014-2899-7","article-title":"An evaluation of clinical risk factors for estimating fracture risk in postmenopausal osteoporosis using an electronic medical record database","volume":"26","author":"Unni","year":"2015","journal-title":"Osteoporos. Int."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1007\/s12020-018-1746-6","article-title":"Association between age at menopause and fracture risk: A systematic review and meta-analysis","volume":"63","author":"Anagnostis","year":"2019","journal-title":"Endocrine"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Zhu, H., Jiang, J., Wang, Q., Zong, J., Zhang, L., Ma, T., and Zhang, L. (2018). Associations between ERalpha\/beta gene polymorphisms and osteoporosis susceptibility and bone mineral density in postmenopausal women: A systematic review and meta-analysis. BMC Endocr. Disord., 18.","DOI":"10.1186\/s12902-018-0230-x"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1590\/1806-9282.64.05.420","article-title":"Functionality, comorbidity, complication surgery of hip fracture in older adults by age distribution","volume":"64","year":"2018","journal-title":"Rev. Assoc. Med. Bras."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1097\/BOR.0000000000000401","article-title":"Fracture Liaison Services","volume":"29","author":"Briot","year":"2017","journal-title":"Curr. Opin. Rheumatol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1080\/08952841.2018.1529473","article-title":"Clinical effectiveness of osteoporosis treatment in older patients: A fracture liaison service-based prospective study","volume":"31","author":"Mugnier","year":"2019","journal-title":"J. Women Aging"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1007\/s00198-015-3415-4","article-title":"Antiresorptive therapy and risk of mortality and refracture in osteoporosis-related hip fracture: A nationwide study","volume":"27","author":"Brozek","year":"2016","journal-title":"Osteoporos. Int."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1111\/ajr.12355","article-title":"Prevention of osteoporotic refractures in regional Australia","volume":"25","author":"Davidson","year":"2017","journal-title":"Aust. J. Rural Health"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1753","DOI":"10.1210\/jc.2018-02236","article-title":"Comparison of Denosumab and Bisphosphonates in Patients With Osteoporosis: A Meta-Analysis of Randomized Controlled Trials","volume":"104","author":"Lyu","year":"2019","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_17","first-page":"85","article-title":"Oral Bisphosphonate Induced Recurrent Osteonecrosis of Jaw with Atypical Femoral Fracture and Subsequent Mandible Fracture in the Same Patient: A Case Report","volume":"8","author":"Pispati","year":"2018","journal-title":"J. Orthop. Case Rep."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1210\/er.2018-00001","article-title":"Atypical Femur Fractures\u2014Review of epidemiology, relationship to bisphosphonates, prevention and clinical management","volume":"40","author":"Black","year":"2019","journal-title":"Endocr. Rev."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Knopp-Sihota, J.A., Cummings, G.G., Homik, J., and Voaklander, D. (2013). The association between serious upper gastrointestinal bleeding and incident bisphosphonate use: A population-based nested cohort study. BMC Geriatr., 13.","DOI":"10.1186\/1471-2318-13-36"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1097\/GME.0000000000000419","article-title":"A 7-year randomized, placebo-controlled trial assessing the long-term efficacy and safety of bazedoxifene in postmenopausal women with osteoporosis: Effects on bone density and fracture","volume":"22","author":"Palacios","year":"2015","journal-title":"Menopause"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1007\/s00198-015-3386-5","article-title":"Calcium plus vitamin D supplementation and risk of fractures: An updated meta-analysis from the National Osteoporosis Foundation","volume":"27","author":"Weaver","year":"2016","journal-title":"Osteoporos. Int."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e8659","DOI":"10.1097\/MD.0000000000008659","article-title":"Efficacy and safety of bazedoxifene in postmenopausal women with osteoporosis: A systematic review and meta-analysis","volume":"96","author":"Peng","year":"2017","journal-title":"Medicine"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1302\/2046-3758.67.BJR-2016-0292.R1","article-title":"The efficacy and safety of vertebral fracture prevention therapies in post-menopausal osteoporosis treatment: Which therapies work best? a network meta-analysis","volume":"6","author":"Wang","year":"2017","journal-title":"Bone Jt. Res."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"929","DOI":"10.1097\/GME.0000000000001321","article-title":"Comparative efficacy and safety of pharmacological interventions for osteoporosis in postmenopausal women: A network meta-analysis (Chongqing, China)","volume":"26","author":"Tan","year":"2019","journal-title":"Menopause"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"4469","DOI":"10.1002\/jcb.26550","article-title":"A network meta-analysis on the short-term efficacy and adverse events of different anti-osteoporosis drugs for the treatment of postmenopausal osteoporosis","volume":"119","author":"Liu","year":"2018","journal-title":"J. Cell Biochem."},{"key":"ref_26","first-page":"2640","article-title":"Drug efficacies on bone mineral density and fracture rate for the treatment of postmenopausal osteoporosis: A network meta-analysis","volume":"23","author":"Yang","year":"2019","journal-title":"Eur. Rev. Med. Pharm. Sci."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"781","DOI":"10.1159\/000453138","article-title":"Network Meta-Analysis of Pharmacological Agents for Osteoporosis Treatment and Fracture Prevention","volume":"40","author":"Yang","year":"2016","journal-title":"Cell Physiol. Biochem."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"b2535","DOI":"10.1136\/bmj.b2535","article-title":"Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement","volume":"339","author":"Moher","year":"2009","journal-title":"BMJ"},{"key":"ref_29","first-page":"773","article-title":"How to Best Predict Fragility Fractures: An Update and Systematic Review","volume":"20","author":"Allon","year":"2018","journal-title":"Isr. Med Assoc. J. IMAJ"},{"key":"ref_30","first-page":"750","article-title":"Short-term efficacy of minimally invasive treatments for adult obstructive sleep apnea: A systematic review and network meta-analysis of randomized controlled trials","volume":"118","author":"Gao","year":"2019","journal-title":"J. Med. Assoc."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1016\/S0140-6736(17)32137-2","article-title":"Effects of teriparatide and risedronate on new fractures in post-menopausal women with severe osteoporosis (VERO): A multicentre, double-blind, double-dummy, randomised controlled trial","volume":"391","author":"Kendler","year":"2018","journal-title":"Lancet"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1417","DOI":"10.1056\/NEJMoa1708322","article-title":"Romosozumab or Alendronate for Fracture Prevention in Women with Osteoporosis","volume":"377","author":"Saag","year":"2017","journal-title":"N. Engl. J. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"756","DOI":"10.1056\/NEJMoa0809493","article-title":"Denosumab for prevention of fractures in postmenopausal women with osteoporosis","volume":"361","author":"Cummings","year":"2009","journal-title":"N. Engl. J. Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1532","DOI":"10.1056\/NEJMoa1607948","article-title":"Romosozumab Treatment in Postmenopausal Women with Osteoporosis","volume":"375","author":"Cosman","year":"2016","journal-title":"N. Engl. J. Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"2443","DOI":"10.1210\/jc.2018-01965","article-title":"Invasive Oral Procedures and Events in Postmenopausal Women With Osteoporosis Treated With Denosumab for Up to 10 Years","volume":"104","author":"Watts","year":"2019","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1186\/s13018-018-0865-3","article-title":"Denosumab compared to bisphosphonates to treat postmenopausal osteoporosis: A meta-analysis","volume":"13","author":"Wu","year":"2018","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1016\/j.bone.2016.05.013","article-title":"Clinical effectiveness of bisphosphonates for the prevention of fragility fractures: A systematic review and network meta-analysis","volume":"89","author":"Sanderson","year":"2016","journal-title":"Bone"},{"key":"ref_38","first-page":"CD004143","article-title":"Long-term hormone therapy for perimenopausal and postmenopausal women","volume":"1","author":"Marjoribanks","year":"2017","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Haguenauer, D., Welch, V., Shea, B., Tugwell, P., and Wells, G. (2000). Fluoride for treating postmenopausal osteoporosis. Cochrane Database Syst. Rev., CD002825.","DOI":"10.1002\/14651858.CD002825"},{"key":"ref_40","unstructured":"Gupta, M., and Gupta, N. (2018). Bisphosphonate Related Jaw Osteonecrosis. StatPearls, StatPearls Publishing."},{"key":"ref_41","first-page":"e1","article-title":"Current management concepts for bisphosphonate-related osteonecrosis of the jaw: A review","volume":"66","author":"Kilic","year":"2018","journal-title":"Gen. Dent."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/j.oooo.2018.09.008","article-title":"Medication-related osteonecrosis of the jaw: Definition and best practice for prevention, diagnosis, and treatment","volume":"127","author":"Mendes","year":"2019","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1007\/s00223-010-9420-x","article-title":"Impact of treatments for postmenopausal osteoporosis (bisphosphonates, parathyroid hormone, strontium ranelate, and denosumab) on bone quality: A systematic review","volume":"87","author":"Gallacher","year":"2010","journal-title":"Calcif. Tissue Int."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1838","DOI":"10.1210\/jc.2009-1703","article-title":"Effects of teriparatide, alendronate, or both in women with postmenopausal osteoporosis","volume":"95","author":"Finkelstein","year":"2010","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"e015187","DOI":"10.1136\/bmjopen-2016-015187","article-title":"Combination therapy of anabolic agents and bisphosphonates on bone mineral density in patients with osteoporosis: A meta-analysis of randomised controlled trials","volume":"8","author":"Lou","year":"2018","journal-title":"BMJ Open"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"e9534","DOI":"10.1097\/MD.0000000000009534","article-title":"Combination therapy of anabolic and nonbisphosphonates antiresorptive agents for the treatment of osteoporosis: A meta-analysis","volume":"96","author":"Lou","year":"2017","journal-title":"Medicine"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1007\/s00198-018-4790-4","article-title":"Combination therapy with parathyroid hormone analogs and antiresorptive agents for osteoporosis: A systematic review and meta-analysis of randomized controlled trials","volume":"30","author":"Lou","year":"2019","journal-title":"Osteoporos. Int."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/14\/3043\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:27:57Z","timestamp":1760164077000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/14\/3043"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,7,8]]},"references-count":47,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2021,7]]}},"alternative-id":["jcm10143043"],"URL":"https:\/\/doi.org\/10.3390\/jcm10143043","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,7,8]]}}}