Bisphosphonates for the prevention of osteoporotic fractures in postmenopausal women with osteopenia: a systematic review and meta-analysis

   BACKGROUND: The lack of sufficient systematization of data on the use of bisphosphonates for primary prevention of osteoporotic fractures in postmenopausal women with osteopenia prompted us to conduct a systematic review with meta-analysis of publications devoted to this problem.
AIM: To study the effect of bisphosphonates on bone mineral density (BMD), markers of bone metabolism and fractures in postmenopausal women with osteopenia.

   MATERIALS AND METHODS: A total of 1140 potentially eligible articles were found in the initial publication screening. From the initially identified results, 13 studies were meta-analyzed. The design of the studies selected for meta-analysis was consistent with randomized controlled trials.

   RESULTS: On average, study bisphosphonate preparations compared with placebo increased lumbar spine BMD by 5.54 % (95 % CI 4.44–6.63, I2 = 93.65 %), total hip BMD by 4.53 % (95 % CI 3. 2–5.86, I2=96.32 %), femoral neck BMD by 3.63 % (95 % CI 1.5–5.75, I2=95.9 %), total body BMD by 3.25 % (95 % CI 2.28–4.22, I2=87.87 %), proximal femur BMD by 4.76 % (95 % CI 3.43–6.08, I2 = 88.64 %). There was a statistically significant effect of bisphosphonates on low-energy fractures (OR 0.62; 95 % CI 0.49–0.77), clinical vertebral fractures (OR 0.51; 95 % CI 0.38–0.69), and radiologically confirmed vertebral fractures (OR 0.63; 95 % CI 0.4–0.98).

   CONCLUSION: These results obtained allow us to conclude that bisphosphonates (alendronate, zolendronic acid, ibandronate, resedronate) have a positive therapeutic effect, and their administration is justified in postmenopausal women with osteopenia for the prevention of osteoporotic fractures and increase in BMD.

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