The influence of anti-osteoporotic drugs on fracture risk, bone mineral density, and side effect in senile osteoporosis treatment: a network meta-analysis of randomized controlled trials

<h2>Abstract</h2> Owing to the acceleration of the aging process in the global population, senile osteoporosis (SOP) induced by degenerative bone tissue disorders causes severe physical and mental agony and a heavy economic burden on society. The overview provided by the current study does not keep pace with the research advances in SOP. We evaluated the efficacy and safety of different anti-osteoporotic drugs for SOP treatment by comparing their influence on fracture risk, bone mineral density (BMD), and side effects through a network meta-analysis. The following outcomes were extracted for comparison: vertebral fractures, clinical fractures, non-vertebral fractures, hip fractures, BMD of the lumbar/femoral neck/total hip/distal radius, procollagen type I N-terminal propeptide, eczema, and vomiting. We used a Bayesian random-effects model for data analysis. A total of 61 randomized controlled trials (RCTs) involving 97,446 participants were included, together with the following drugs: bisphosphonates (including alendronate, zoledronate, ibandronate, and risedronate), selective estrogen receptor modulators (including raloxifene and bazedoxifene), denosumab, parathyroid hormone/parathyroid hormone related peptide analog (PTH/PTHrP analog, including parathyroid hormone, teriparatide, and abaloparatide), sclerostin inhibitors (romosozumab), odanacatib, sodium fluoride, and calcitonin. PTH/PTHrP analog were optimal for reducing the risk of vertebral fractures in elderly individuals with osteoporosis. Romosozumab was the most effective in improving the BMD of the lumbar spine in elderly individuals with osteoporosis. Evidence shows that most of the included drugs are beneficial for the treatment of osteoporosis in the elderly population. PTH/PTHrP analog and romosozumab are optimal for individuals with SOP improve BMD of the lumbar spine and reduce the vertebral fracture rate.