What is the Relative Risk Reduction (RRR) of fractures for each osteoporosis medication?

From the Guidelines

Denosumab has a Relative Risk Reduction (RRR) of fractures ranging from 32% to 62% for vertebral fractures and 21% to 49% for nonvertebral fractures, as shown in the FREEDOM trial 1.

• The RRR for vertebral fractures was 68% in the ABCSG-18 trial 1 and 32% in the FREEDOM trial 1.
• The RRR for nonvertebral fractures was 20% in the FREEDOM trial 1 and 49% in the open-label extension of the FREEDOM trial 1.
• Zoledronic acid has been shown to reduce the risk of vertebral fractures by 50% and nonvertebral fractures by 25% in the HORIZON-PFT trial, although the exact RRR is not provided in the given evidence 1.
• Bazedoxifene has a RRR of 35-40% for nonvertebral fractures and 36.5% for vertebral fractures, as shown in the study by Palacios et al 1.
• Teriparatide has been shown to reduce the risk of nonvertebral and morphometric vertebral fractures by 66% and 34% respectively, although the exact RRR is not provided in the given evidence 1.
• Alendronate and risedronate are first-choice agents for the treatment of osteoporosis, but the exact RRR for these medications is not provided in the given evidence 1.
• The American College of Physicians recommends offering pharmacologic treatment with alendronate, risedronate, zoledronic acid, or denosumab to reduce the risk for hip and vertebral fractures in women with known osteoporosis 1.

From the Research

Relative Risk Reduction (RRR) of Fractures for Each Osteoporosis Medication

The following medications have been studied for their effectiveness in reducing the risk of fractures:

• Risedronate:
  • Vertebral fractures: 39% RRR 2
  • Non-vertebral fractures: 20% RRR 2
  • Hip fractures: 26% RRR 2
• Romosozumab:
  • Vertebral fractures: 76% RRR 3, 66% RRR 4
  • Clinical fractures: 60% RRR 3, 27% RRR 4
  • Non-vertebral fractures: 54% RRR 3, 21% RRR 4
• Denosumab:
  • No direct RRR values are provided, but it is used in combination with romosozumab to maintain fracture risk reduction 4
• Alendronate, Risedronate, Zoledronic acid, and Denosumab:
  • These medications are associated with a lower mortality risk, but no direct RRR values are provided for fractures 5
• Strontium ranelate:
  • No direct RRR values are provided, but it has the lowest number needed to treat (NNT) for the prevention of both vertebral and hip fracture 6
• Other bisphosphonates (e.g. ibandronate):
  • No direct RRR values are provided, but they have higher NNT values compared to strontium ranelate 6