Table A Summary of major studies showing effect of pharmacological treatment on fracture
Agent and study |
Indication for treatment |
No of patients |
Mean age (range) |
Duration (years) |
Type of fracture (relative risk, 95% CI) |
NNT (95% CI) |
Comments |
Combined calcium and vitamin D: |
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Chapuy et al 1992w1 |
NS |
1505 |
84 |
1.5 |
Hip fracture (0.70, 0.62 to 0.78); other fractures (0.70, 0.51 to 0.91) |
47 (24 to 429); 24 (14 to 90) |
Adequate design and large size, but limited to institutionalised patients without normal exposure to sunlight |
Combined estradiol and medroxyprogesterone: |
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Lufkin et al 1992w11 |
Osteoporosis and fracture |
75 |
65 |
1 |
Vertebral fractures |
NS |
Limited owing to small size and short duration |
Rossouw et al 2002w8 |
Postmenopause |
16 608 |
63 (50-79) |
5.2 |
All fractures (0.76, 0.69 to 0.85); osteoporotic fractures (0.77, 0.69 to 0.86); hip fracture (0.66, 0.45 to 0.98) |
48 (34 to 82); 55 (38 to 97); 404 (200 to 17451) |
Large scale randomised study. Wide confidence intervals for numbers needed to treat mirrors relatively low risk for hip fracture in total population |
Combined estradiol and noretisterone or estradiol alone: |
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Mosekilde et al 2000w12 |
Postmenopause |
1006 |
50 |
5 |
All types of fractures |
NS |
Reduction in wrist fractures when randomised, and open label patients were pooled |
Raloxifene 60 mg: |
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Ettinger et al 1999w7 |
Osteoporosis; osteoporosis and fracture; osteoporosis and fracture |
3012; 1539; 7705 |
67 (31-80) |
3 |
Vertebral fractures (0.5, 0.4 to 0.8); vertebral fractures (0.7, 0.6 to 0.9); non-vertebral fractures (0.9, 0.8 to 1.1) |
48 (29 to 120); 16 (10 to 38); NS |
Adequate design and large size, with effect only on vertebral fractures |
Calitonin: |
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Chesnut et al 2000w9 |
Vertebral fracture |
1255 |
70 |
5 |
Vertebral fractures (0.67, 0.47 to 0.97) |
13 (7 to 77) |
Effect at 200 IU dose, not higher dose. High discontinuation rate |
Parathyroid hormone: |
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Neer et al 2001w10 |
Vertebral fracture |
1637 |
70 |
21* |
Vertebral fractures (0.31, 0.22 to 0.55); non-vertebral fractures (0.47, 0.25 to 0.88) |
11 (8 to 18); 29 (15 to 438) |
Fracture reduction in high risk patients. Study prematurely ended; planned for 24 months |
NNT=number needed to treat; NS=not specified.
*Months.