Systematic review and meta-analysis of the efficacy and safety of alendronate and zoledronate for the treatment of postmenopausal osteoporosis

Gynecol Endocrinol. 2013 Dec;29(12):1005-14. doi: 10.3109/09513590.2013.813468. Epub 2013 Sep 25.


The aim of this meta-analysis was to evaluate the efficacy and safety of two bisphosphonates (alendronate and zoledronate) in the treatment of postmenopausal osteoporosis. The incidence of fractures was considered as primary endpoint. Only randomized trials with a follow-up period of 1 year or more were included in this systematic review and meta-analysis. We excluded studies that included patients with secondary osteoporosis especially in relation to therapy with corticosteroids or other drugs or diseases known to affect bone mineral density. Studies published as subgroup analysis, extension studies, economic evaluations, and comparisons with active control were excluded. The methodological quality of controlled clinical trials that met these inclusion criteria was evaluated. No studies were excluded from analysis due to lack of quality. The risk ratio of hip, vertebral and wrist fractures for alendronate were 0.61 [95% confidence interval (CI) 0.40-0.93], 0.54 (95% CI 0.44-0.66) and 0.65 (95% CI 0.33-1.25), respectively. Zoledronate risk ratio was 0.62 (95% CI 0.46-0.82) and 0.38 (95% CI 0.22-0.67) for hip and vertebral fractures, respectively.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Alendronate / adverse effects
  • Alendronate / therapeutic use*
  • Bone Density
  • Bone Density Conservation Agents / therapeutic use*
  • Diphosphonates / adverse effects
  • Diphosphonates / therapeutic use*
  • Female
  • Fractures, Bone / epidemiology
  • Hip Fractures / epidemiology
  • Humans
  • Imidazoles / adverse effects
  • Imidazoles / therapeutic use*
  • Middle Aged
  • Osteoporosis, Postmenopausal / drug therapy*
  • Randomized Controlled Trials as Topic
  • Spinal Fractures / epidemiology
  • Zoledronic Acid


  • Bone Density Conservation Agents
  • Diphosphonates
  • Imidazoles
  • Zoledronic Acid
  • Alendronate