What are the comparative fracture risk reductions with Fosamax (Alendronate), Reclast (Zoledronic acid), Forteo (Teriparatide), Evenity (Romosozumab), and Evista (Raloxifene) in treatment-naive patients?

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The FDA Drug Labels for alendronate (PO), zoledronic acid (IV), denosumab (SQ), teriparatide (SQ), romosozumab (SQ), raloxifene (PO) do not address this question.

From the Research

Comparative Fracture Risk Reductions

The following medications are used to treat osteoporosis: Fosamax (Alendronate), Reclast (Zoledronic acid), Forteo (Teriparatide), Evenity (Romosozumab), and Evista (Raloxifene).

  • Fosamax (Alendronate):
    • Reduced the risk of major osteoporotic fractures by 39% compared to denosumab is not accurate, denosumab reduced the risk by 39% compared to alendronate 1
    • Reduced the risk of vertebral fractures, but the exact percentage is not provided in the given studies
  • Reclast (Zoledronic acid):
    • Seemed the most effective in preventing vertebral fracture, nonvertebral fracture, and any fracture 2
    • Had a relative risk of 0.30 for vertebral fractures relative to placebo, and 0.55 relative to alendronate 3
  • Forteo (Teriparatide):
    • Increased bone mineral density more than antiresorptives and reduced the risk of vertebral and non-vertebral fractures by 85% and 40-50%, respectively, compared to placebo 4
    • Ranked highest in new non-vertebral fractures prevention 5
  • Evenity (Romosozumab):
    • Led to more pronounced increases in BMD than other treatment modalities and reduced the risk of vertebral and clinical fractures by 73% and 36% compared to placebo after 12 months 4
  • Evista (Raloxifene):
    • Exhibited no significant difference in wrist fractures prevention, and had a lower risk of adverse events compared to zoledronic acid 5

Fracture Risk Reduction Comparison

  • Zoledronic acid seemed the most effective in preventing vertebral fracture, nonvertebral fracture, and any fracture 2
  • Teriparatide ranked highest in new non-vertebral fractures prevention 5
  • Denosumab reduced the risk of major osteoporotic fractures by 39% compared to alendronate 1
  • Romosozumab reduced the risk of vertebral and clinical fractures by 73% and 36% compared to placebo after 12 months 4

References

1
Research

Comparative effectiveness of denosumab vs alendronate among postmenopausal women with osteoporosis.

Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research, 2024

2
Research

Comparative efficacy of bisphosphonates in short-term fracture prevention for primary osteoporosis: a systematic review with network meta-analyses.

Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 2016

5
Research

Network Meta-Analysis of Pharmacological Agents for Osteoporosis Treatment and Fracture Prevention.

Cellular physiology and biochemistry : international journal of experimental cellular physiology, biochemistry, and pharmacology, 2016

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