Effects of different anti-osteoporosis medications on re-fracture risk, bone mineral density, and functional recovery following hip fragility fracture surgery: a systematic review and network meta-analysis
- 1College of Chinese Medicine, Changchun University of Chinese Medicine
- 2Department of Orthopedics, Affiliated Hospital of Changchun University of Chinese Medicine
- 3Department of Orthopedics, Third Affiliated Hospital of Changchun University of Chinese Medicine
Abstract
Background: Patients undergoing surgery for fragility hip fracture remain at high risk of refracture and poor functional recovery. This study compared the effects of commonly used anti-osteoporosis medications on postoperative outcomes.
Methods: PubMed, Embase, Web of Science, and the Cochrane Library were searched from January 1, 2015, to April 15, 2026. Randomized and non-randomized comparative studies were eligible. Bayesian random-effects consistency-model network meta-analyses assessed refracture, hip bone mineral density expressed as g/cm ² or T-scores, Harris Hip Score, and visual analog scale scores. Leave-one-out sensitivity analyses were conducted for all outcomes. For HHS and VAS, RCT-only analyses were performed when the available RCTs formed connected networks, and analyses restricted to exactly 12 months of follow-up were conducted where feasible. The certainty of evidence was assessed using the GRADE approach.
Results: Eighteen studies involving 2,414 patients were included. Comparative effects varied by outcome and follow-up duration, with no consistent evidence of treatment superiority. Ranking patterns suggested relatively favorable signals for ZOL and DEN in 12-month hip refracture, ZOL and ALN in 12-month overall refracture, and TPTD and DEN in 24-month overall refracture, but were interpreted as descriptive summaries. BMD ranking patterns varied according to reporting format, and no clear differences were found for BMD, HHS, or VAS. Leave-one-out sensitivity analyses showed broadly stable findings, and the additional RCT-only and exact 12-month analyses for HHS and VAS were generally consistent with the primary analyses. GRADE assessments indicated limited certainty of evidence across outcomes.
Conclusion: Anti-osteoporosis medications showed outcome- and time-specific efficacy patterns, but no consistent superiority was demonstrated. ZOL, DEN, and ALN showed relatively favorable signals for some early refracture outcomes, whereas TPTD showed a more favorable pattern for longer-term bone mass restoration. Given the limited and predominantly low-certainty evidence, these findings should be interpreted as contextual efficacy signals rather than treatment recommendations.
Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261363237 , identifier CRD420261363237.
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BibTeX
@article{tian2026effects,
title = {{Effects of different anti-osteoporosis medications on re-fracture risk, bone mineral density, and functional recovery following hip fragility fracture surgery: a systematic review and network meta-analysis}},
author = {Jingnan Tian and Hang Zhang and Yuchi Lu and Hailong Wu and Yan Lu and Dongxu Yu and Lianhe Yu and Zongjian Luo},
journal = {Frontiers in Endocrinology},
year = {2026},
month = oct,
doi = {10.3389/fendo.2026.1949781},
url = {https://www.frontiersin.org/articles/10.3389/fendo.2026.1949781/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Effects of different anti-osteoporosis medications on re-fracture risk, bone mineral density, and functional recovery following hip fragility fracture surgery: a systematic review and network meta-analysis
AU - Jingnan Tian
AU - Hang Zhang
AU - Yuchi Lu
AU - Hailong Wu
AU - Yan Lu
AU - Dongxu Yu
AU - Lianhe Yu
AU - Zongjian Luo
PY - 2026
DA - 2026/10/20
JO - Frontiers in Endocrinology
DO - 10.3389/fendo.2026.1949781
UR - https://www.frontiersin.org/articles/10.3389/fendo.2026.1949781/full
AB - Background: Patients undergoing surgery for fragility hip fracture remain at high risk of refracture and poor functional recovery. This study compared the effects of commonly used anti-osteoporosis medications on postoperative outcomes. Methods: PubMed, Embase, Web of Science, and the Cochrane Library were searched from January 1, 2015, to April 15, 2026. Randomized and non-randomized comparative studies were eligible. Bayesian random-effects consistency-model network meta-analyses assessed refracture, hip bone mineral density expressed as g/cm ² or T-scores, Harris Hip Score, and visual analog scale scores. Leave-one-out sensitivity analyses were conducted for all outcomes. For HHS and VAS, RCT-only analyses were performed when the available RCTs formed connected networks, and analyses restricted to exactly 12 months of follow-up were conducted where feasible. The certainty of evidence was assessed using the GRADE approach. Results: Eighteen studies involving 2,414 patients were included. Comparative effects varied by outcome and follow-up duration, with no consistent evidence of treatment superiority. Ranking patterns suggested relatively favorable signals for ZOL and DEN in 12-month hip refracture, ZOL and ALN in 12-month overall refracture, and TPTD and DEN in 24-month overall refracture, but were interpreted as descriptive summaries. BMD ranking patterns varied according to reporting format, and no clear differences were found for BMD, HHS, or VAS. Leave-one-out sensitivity analyses showed broadly stable findings, and the additional RCT-only and exact 12-month analyses for HHS and VAS were generally consistent with the primary analyses. GRADE assessments indicated limited certainty of evidence across outcomes. Conclusion: Anti-osteoporosis medications showed outcome- and time-specific efficacy patterns, but no consistent superiority was demonstrated. ZOL, DEN, and ALN showed relatively favorable signals for some early refracture outcomes, whereas TPTD showed a more favorable pattern for longer-term bone mass restoration. Given the limited and predominantly low-certainty evidence, these findings should be interpreted as contextual efficacy signals rather than treatment recommendations. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261363237 , identifier CRD420261363237.
SN - 1664-2392
ER -