(HealthDay News) — Good-quality evidence supports the efficacy of several medications for osteoporosis, but the comparative effectiveness of these drugs is unclear, according to research published in the Annals of Internal Medicine.

Carolyn J. Crandall, MD, of the University of California, Los Angeles, and colleagues updated a review of the literature with 294 articles about the benefits and harms of pharmacologic treatments to prevent fractures in at-risk adults.

The researchers found high-strength evidence that bisphosphonates, denosumab and teriparatide, compared with placebo, reduce risk for vertebral fractures (relative risk [RR]=0.4-0.6) and nonvertebral fractures (RR=0.6-0.8). 

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In placebo-controlled trials, raloxifene was found to reduce risk for vertebral fractures only. 

Since 2007, atypical subtrochanteric femur fracture has been recognized as an adverse effect associated with bisphosphonate therapy. Adverse effects, including gastrointestinal reactions, hot flashes, thromboembolic eventsand infections, vary among these agents.

“There are many limitations to our review,” the researchers wrote. “The most important of these is the dearth of head-to-head comparisons of the benefits and harms of the agents.”

One author disclosed financial ties to the pharmaceutical industry.


  1. Crandall CJ et al. Ann Intern Med. 2014;doi:10.7326/M14-0317.