Does Alendronate reduce the risk of fracture in men? A meta-analysis incorporating prior knowledge of anti-fracture efficacy in women
1 Department of Medicine, St. Joseph's Healthcare and McMaster University, Hamilton, Ontario, Canada
2 Division of Endocrinology and Metabolism, McMaster University, Hamilton, Ontario, Canada
3 Graduate Student in Health Research Methodology, McMaster University, Hamilton, Ontario, Canada
4 Department of Medicine, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
5 Division of Geriatrics, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
6 Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
7 Division of Rheumatology, St. Joseph's Healthcare and McMaster University, Hamilton, Ontario, Canada
8 Division of Endocrinology and Metabolism, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
9 Centre for Evaluation of Medicines, St. Joseph's Healthcare, Hamilton, Ontario, Canada
BMC Musculoskeletal Disorders 2005, 6:39 doi:10.1186/1471-2474-6-39Published: 11 July 2005
Alendronate has been found to reduce the risk of fractures in postmenopausal women as demonstrated in multiple randomized controlled trials enrolling thousands of women. Yet there is a paucity of such randomized controlled trials in osteoporotic men. Our objective was to systematically review the anti-fracture efficacy of alendronate in men with low bone mass or with a history of prevalent fracture(s) and incorporate prior knowledge of alendronate efficacy in women in the analysis.
We examined randomized controlled trials in men comparing the anti-fracture efficacy of alendronate to placebo or calcium or vitamin D, or any combination of these. Studies of men with secondary causes of osteoporosis other than hypogonadism were excluded. We searched the following electronic databases (without language restrictions) for potentially relevant citations: Medline, Medline in Process (1966-May 24/2004), and Embase (1996–2004). We also contacted the manufacturer of the drug in search of other relevant trials. Two reviewers independently identified two trials (including 375 men), which met all inclusion criteria. Data were abstracted by one reviewer and checked by another. Results of the male trials were pooled using Bayesian random effects models, incorporating prior information of anti-fracture efficacy from meta-analyses of women.
The odds ratios of incident fractures in men (with 95% credibility intervals) with alendronate (10 mg daily) were: vertebral fractures, 0.44 (0.23, 0.83) and non-vertebral fractures, 0.60 (0.29, 1.44).
In conclusion, alendronate decreases the risk of vertebral fractures in men at risk. There is currently insufficient evidence of a statistically significant reduction of non-vertebral fractures, but the paucity of trials in men limit the statistical power to detect such an effect.