SYSTEMATIC REVIEW article
Front. Endocrinol.
Sec. Bone Research
Volume 16 - 2025 | doi: 10.3389/fendo.2025.1579101
The Efficacy and Safety of Denosumab, Risedronate, Alendronate and Teriparatide to Treat Male Osteoporosis: A Systematic Review and Bayesian Network Meta-Analysis
Provisionally accepted
- 1The Third Affiliated Hospital of Inner Mongolia Medical University, Inner Mongolia, China
- 2the Second Hospital of Jilin University, Changchun, Hebei Province, China
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Background: Male osteoporosis treatment lacks robust comparisons of efficacy and safety among key medications. This network meta-analysis (NMA) aimed to systematically evaluate alendronate (ALE), risedronate (RIS), teriparatide (TER), and denosumab (DEN) in male patients, addressing this critical evidence gap.Methods: Following PRISMA 2020 guidelines, we conducted a systematic review and NMA. Databases were searched for randomized controlled trials (RCTs) comparing these drugs in males with osteoporosis (PICOS criteria). Pairwise meta-analysis (Stata 18.0) assessed effect sizes, while NMA (R 4.3.1, gemtc and BUGSnet packages) ranked treatments for BMD changes (lumbar spine, femoral neck, total hip) and safety outcomes (adverse and serious adverse events).Results: From 2729 screened records, 12 studies were included. TER ranked highest for lumbar spine BMD improvement and overall safety (lowest adverse events). ALE showed superior femoral neck and total hip BMD gains but higher adverse event risks vs. TER. DEN improved BMD at all sites but had the poorest safety profile (highest adverse events). RIS was safest (lowest serious adverse events) but least effective for BMD enhancement.Conclusions: Teriparatide is the optimal choice for improving lumbar spine BMD and overall safety, while alendronate shows significant efficacy in enhancing femoral neck and hip BMD, although its safety profile is less favorable. Thus, alendronate may be more suitable for patients needing bone density improvement at these sites. Treatment choices should weigh site-specific needs against risk tolerance.
Keywords: Systematic review, Denosumab, Risedronate, Alendronate, Teriparatide, Network meta-analysis
Received: 18 Feb 2025; Accepted: 13 May 2025.
Copyright: © 2025 Chai, Yu, Wang, Sun, Xue, Zhang and Ran. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Bo Ran, The Third Affiliated Hospital of Inner Mongolia Medical University, Inner Mongolia, China
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