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Rheumatology International
Published in: Rheumatology International 12/2011

01-12-2011 | Letter to the Editor

Should we really compare absolute risk reduction in different trials on osteoporosis: comment on the article by Ringe JD and Doherty JG

Author: Zhanna E. Belaya

Published in: Rheumatology International | Issue 12/2011

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Excerpt

After reading the article “Absolute risk reduction in osteoporosis: assessing treatment efficacy by number needed to treat” by Ringe and Doherty [1], many people would probably feel sheer and utter astonishment at the “great idea” of a “simplified approach”… Indeed, how is it possible that relative risk for vertebral fractures 0.59 (95% CI 0.48–0.73) in the SOTI trial (strontium ranelate) [2] would turn into a nice number needed to treat (NNT)—9 “to reduce one vertebral fracture”, but the relative risk 0.5 (95% CI 0.26–0.66) for intermittent ibandronate in the BONE clinical trial [3] is 21 postmenopausal women to be treated to avoid one vertebral fracture. Who is responsible for this? The agent or the populations that were involved in the clinical trials? …
Literature
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Ringe JD, Doherty JG (2009) Absolute risk reduction in osteoporosis: assessing treatment efficacy by number needed to treat. Rheumatology International, published online 25 Dec 2009, doi:10.​1007/​s00296-009-1311-y
2.
Meunier PJ, Roux C, Seeman E, Ortolani S, Badurski JE, Spector TD, Cannata J, Dalogh A, Lemmel E, Nielsen S, Rizzoli R, Genant HK, Reginster J (2004) The effects of strontium ranelate on the risk of vertebral fracture in women with postmenopausal osteoporosis. N Engl J Med 350:459–468PubMedCrossRef
3.
Chesnut CH, Skag A, Christiansen C, Recker R, Stakkestad JA, Hoiseth A, Felsenberg D, Huss H, Gibride J, Schimmer RC, Delmas PD (2004) Effects of oral ibandronate administered daily or intermittently on fracture risk in postmenopausal osteoporosis. J Bone Miner Res 19:1241–1249CrossRef
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Campbel MJ, Machin D (2003) Medical statistics a commonsense approach, pp 62–63
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Kanis JA, Johnell O, Oden A, Johansson H, McCloskey E (2008) FRAX and the assessment of fracture probability in men and women from the UK. Osteoporos Int 19:385–397PubMedCrossRef
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Reginster JY, Seeman E, Vernejoul MC, Adami S, Compston J, Phenekos C, Devogelaer JP, Curiel MD, Sawicki A, Goemaere S, Sorensen OH, Felsenberg D, Meunier PJ (2005) Strontium ranelate reduces the risk of nonvertebral fractures in postmenopausal women with osteoporosis: treatment of peripheral osteoporosis (TROPOS) study. J Clin Endocrinol Metab 90:2816–2822PubMedCrossRef
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Black DM, Delmas PD, Eastell R, Reid IR, Boonen S, Cauley JA, Cosman F, Lakatos P, Leung PC et al (2007) Once-yearly zoledronic acid for treatment of postmenopausal osteoporosis. N Engl J Med 356:1809–1822PubMedCrossRef
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O’Donnel S, Cranney A, Wells GA, Adachi J, Reginster JY (2008) Strontium ranelate for preventing and treating osteoporosis. The Cochrane Library, Issue 4
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Wilkes MM, Navickis RJ, Chan WW, Lewiecki EM (2010) Bisphosphonates and osteoporotic fractures: a cross-design synthesis of results among compliant/persistent postmenopausal women in clinical practice versus randomized controlled trials. J Osteoporos Int 21:679–688CrossRef
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O’Donnell S, Moher D, Kelli Thomas K, Hanley DA, Cranney A (2008) Systematic review of the benefits and harms of calcitriol and alfacalcidol for fractures and falls. J Bone Miner Metab 26:531–542PubMedCrossRef
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Cummings SR, Martin JS, McClung MR, Siris ES, Eastell R, Reid IR, Pierre Delmas P, Zoog HB, Austin M, Wang A, Kutilek S, Adami S, Zanchetta J, Libanati C, Siddhanti S, Christiansen C (2009) For the Freedom trial: denosumab for prevention of fractures in postmenopausal women with osteoporosis. N Engl J Med 361:756–765PubMedCrossRef
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Recker RR, Marin F, Ish-Shalom S, Moricke R, Hawkins F, Kapetanos G, de la Pena MP, Kekow J, Farrerons J, Sanz B, Oertel H, Stepan J (2009) Comparative effects of teriparatide and strontium ranelate on bone biopsies and biochemical markers of bone turnover in postmenopausal women with osteoporosis. J Bone Miner Res 24:1358–1368PubMedCrossRef
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Blake CB, Compston JE, Fogelman I (2009) Could strontium ranelate have a synergistic role in the treatment of osteoporosis? J Bone Miner Res 24. Published online on 15 June. doi:10.​1359/​JBMR.​090601
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Li C, Paris O, Siegel S, Roschger P, Paschali EP, Klaushofer, Fratzl KP (2009) Strontium is incorporated into mineral crystals only in newly formed bone during strontium ranelate treatment. JBMR [epub ached of printing]
Metadata
Title
Should we really compare absolute risk reduction in different trials on osteoporosis: comment on the article by Ringe JD and Doherty JG
Author
Zhanna E. Belaya
Publication date
01-12-2011
Publisher
Springer-Verlag
Published in
Rheumatology International / Issue 12/2011
Print ISSN: 0172-8172
Electronic ISSN: 1437-160X
DOI
https://doi.org/10.1007/s00296-010-1626-8

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Keynote webinar | Spotlight on medication adherence

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WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

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