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CER 53: Treatment to Prevent Fractures in Men and Women with Low Bone Density Or Osteoporosis

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CER 53: Treatment to Prevent Fractures in Men and Women with Low Bone Density Or Osteoporosis Comparative Effectiveness Review Number 53 Treatment To Prevent Fractures in Men and Women With Low Bone Density or Osteoporosis: Update of a 2007 Report Archived: This report is greater than 3 years old. Findings may be used for research purposes, but should not be considered current. Archived: This report is greater than 3 years old. Findings may be used for research purposes, but should not be considered current. Comparative Effectiveness Review Number 53 Treatment To Prevent Fractures in Men and Women With Low Bone Density or Osteoporosis: Update of a 2007 Report Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services 540 Gaither Road Rockville, MD 20850 www.ahrq.gov Contract No. HHSA-290-2007-10062-I Prepared by: Southern California Evidence-based Practice Center—RAND Corporation Santa Monica, CA Investigators: Carolyn J. Crandall, M.D., M.S. Sydne J. Newberry, Ph.D. Allison Diamant, M.D., M.S.H.S. Yee-Wei Lim, M.D., Ph.D. Walid F. Gellad, M.D., M.P.H. Marika J. Suttorp, M.S. Aneesa Motala, B.A. Brett Ewing, M.S. Beth Roth, M.A. Roberta Shanman, M.L.S. Martha Timmer, M.S. Paul G. Shekelle, M.D., Ph.D. Note: Several studies in this report have been retracted. They are indicated in the References section. More information is located on the journals’ websites and the Retraction Watch database. AHRQ Publication No. 12-EHC023-EF March 2012 Archived: This report is greater than 3 years old. Findings may be used for research purposes, but should not be considered current. This report is based on research conducted by the Southern California Evidence-based Practice Center under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD, under Contract No. HHSA-290-2001-10062-I. The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services. The information in this report is intended to help health care decisionmakers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients. This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied. This document is in the public domain and may be used and reprinted without permission except those copyrighted materials that are clearly noted in the document. Further reproduction of those copyrighted materials is prohibited without the specific permission of copyright holders. Persons using assistive technology may not be able to fully access information in this report. For assistance contact [email protected]. None of the investigators has any affiliations or financial involvement that conflicts with the material presented in this report. Suggested Citation: Crandall CJ, Newberry SJ, Gellad WG, Diamant A, Lim YW, Suttorp M, Motala A, Ewing B, Roth B, Timmer M, Shanman R, Shekelle PG. Treatment to Prevent Fractures in Men and Women with Low Bone Density or Osteoporosis: Update of a 2007 Report. Comparative Effectiveness Review No. 53. (Prepared by Southern California Evidence-based Practice Center under Contract No. HHSA-290-2007-10062-I.) Rockville, MD: Agency for Healthcare Research and Quality; March 2012. www.effectivehealthcare.ahrq.gov/ reports/final.cfm. ii Archived: This report is greater than 3 years old. Findings may be used for research purposes, but should not be considered current. Preface The Agency for Healthcare Research and Quality (AHRQ) conducts the Effective Health Care Program as part of its mission to organize knowledge and make it available to inform decisions about health care. As part of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, Congress directed AHRQ to conduct and support research on the comparative outcomes, clinical effectiveness, and appropriateness of pharmaceuticals, devices, and health care services to meet the needs of Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). AHRQ has an established network of Evidence-based Practice Centers (EPCs) that produce Evidence Reports/Technology Assessments to assist public- and private-sector organizations in their efforts to improve the quality of health care. The EPCs now lend their expertise to the Effective Health Care Program by conducting Comparative Effectiveness Reviews (CERs) of medications, devices, and other relevant interventions, including strategies for how these items and services can best be organized, managed, and delivered. Systematic reviews are the building blocks underlying evidence-based practice; they focus attention on the strength and limits of evidence from research studies about the effectiveness and safety of a clinical intervention. In the context of developing recommendations for practice, systematic reviews are useful because they define the strengths and limits of the evidence, clarifying whether assertions about the value of the intervention are based on strong evidence from clinical studies. For more information about systematic reviews, see http://effectivehealthcare.ahrq.gov/reference/purpose.cfm AHRQ expects that CERs will be helpful to health plans, providers, purchasers, government programs, and the health care system as a whole. In addition, AHRQ is committed to presenting information in different formats so that consumers who make decisions about their own and their family’s health can benefit from the evidence. Transparency and stakeholder input are essential to the Effective Health Care Program. Please visit the Web site (www.effectivehealthcare.ahrq.gov) to see draft research questions and reports or to join an email list to learn about new program products and opportunities for input. Comparative Effectiveness Reviews will be updated regularly. Carolyn M. Clancy, M.D. Jean Slutsky, P.A., M.S.P.H. Director Director, Center for Outcomes and Evidence Agency for Healthcare Research and Quality Agency for Healthcare Research and Quality Stephanie Chang, M.D., M.P.H. Supriya Janakiraman, M.D, M.P.H Director, Evidence-based Practice Program Task Order Officer Center for Outcomes and Evidence Center for Outcomes and Evidence Agency for Healthcare Research and Quality Agency for Healthcare Research and Quality iii Archived: This report is greater than 3 years old. Findings may be used for research purposes, but should not be considered current. Acknowledgments This study was supported by the Agency for Healthcare Research and Quality. The investigators deeply appreciate the considerable support, commitment and contributions of Megan Clifford, Jianhui Hu, Breanne Johnsen, Tanja Perry and Di Valentine. Technical Expert Panel Roberta Biegel Catherine Maclean, M.D., Ph.D. Senior Director Staff Vice President, Performance Public Policy and Government Relations Measurement National Osteoporosis Foundation WellPoint, Inc. Washington, DC Thousand Oaks, CA Bruce Ettinger, M.D. Paul Miller, M.D. Clinical Professor Medical Director University of California San Francisco Colorado Center for Bone Research San Francisco, CA Lakewood, CO Theodore Hahn, M.D. Eric Orwoll, M.D. Professor in Residence Endocrinologist UCLA Medical Center, Oregon Health and Science University Geriatric Research Education and Clinical Portland, OR Center and VA Greater Los Angeles Healthcare Marcel Salive, M.D., M.P.H. System Director, Division of Medical and Surgical Los Angeles, CA Services Centers for Medicare and Medicaid Services Marc Hochberg, M.D., M.P.H. Baltimore, MD Professor of Medicine Head, Division of Rheumatology and William Schwab, M.D., Ph.D., AGSF Clinical Immunology Chief of Geriatric Services Professor of Epidemiology and Preventive Kaiser Permanente of Ohio Medicine Cleveland Heights, OH University of Maryland Baltimore, MD Daniel Solomon, M.D., M.P.H, Associate Professor of Medicine Hau Liu, M.D. Harvard Medical School Director, Chronic Care Management Brigham and Women’s Hospital Associate Chief, Endocrinology and Division of Rheumatology, Immunology Metabolism and Allergy Santa Clara Valley Boston, MA Clinical Assistant Professor of Medicine Stanford University San Jose and Stanford, CA iv Archived: This report is greater than 3 years old. Findings may be used for research purposes, but should not be considered current. Peer Reviewers Steve Cummings, M.D., FACP Conrad C. Johnston, M.D. San Francisco Coordinating Center Indiana University School of Medicine California Pacific Medical Center Indianapolis, IN California Pacific Medical Center Research Institute Ethel Siris, M.D. University of California, San Francisco Columbia University Medical Center San Francisco, CA New York, NY Rochelle Fu, Ph.D. Oregon Health and Science University Portland, OR Disclosure: Service
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