Priority interventions for the prevention of falls or fractures in patients with osteoporosis: A network meta-analysis

Abstract

Background

The fractures of patients with osteoporosis represent a major health care burden that requires efficient prevention.

Objective

To analyze the efficacy and significance of diverse interventions for preventing falls or fractures in patients with osteoporosis, and to establish a foundation for clinical interventions.

Methods

Ten databases were searched for studies published before January 30, 2024. Screening, data extraction, and risk of bias assessment were independently conducted by two researchers using Stata 14.0 software. A network meta-analysis using the frequentist framework was then performed to determine the effectiveness of various interventions for preventing and managing falls and fractures in patients with osteoporosis. The findings were used as basis for the prioritization of interventions.

Results

The initial search yielded 3894 studies. After 3878 studies were excluded, 16 studies were finally included. For the prevention of falls in patients with osteoporosis, effective interventions include exercise and exercise plus medication. A combination of exercise, assessment and modifications, quality improvement strategies, social engagement, basic falls risk assessment, and assistive technology may be the preferred recommended intervention. For the prevention of fractures in patients with osteoporosis, no statistically significant disparities were observed among the compared interventions, exercise may be the preferred recommended intervention.

Conclusion

Exercise and exercise plus medication are effective in reducing the number of falls in patients with osteoporosis. Although exercise may be the optimal intervention for fracture prevention, the quality of current evidence remains inadequate. Large-scale high-quality randomized controlled trials are necessary to substantiate these findings.

Trial registration

PROSPERO CRD42024507487