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Effect of bisphosphonate on hip fracture in patients with osteoporosis or osteopenia according to age: a meta-analysis and systematic review
  1. Sichun Zhao1,
  2. Wen Zhao2,
  3. Dongpeng Du1,
  4. Chunhao Zhang1,
  5. Tao Zhao1,
  6. Liwen Zheng1,
  7. Leiming Jin1,
  8. Minghao Gu1,
  9. Junfeng Xu1,
  10. Zhonghua Yang3
  1. 1 Department of Orthopedics, Chengdu BOE Hospital, Chengdu, Sichuan, China
  2. 2 Department of Clinical Immunology, The Affiliated Hospital of Northwest University, Xi'an, Shaanxi, China
  3. 3 Department of Geriatrics, Sichuan University West China Hospital, Chengdu, Sichuan, China
  1. Correspondence to Dr Sichun Zhao, Department of Orthopedics, Chengdu BOE Hospital, Chengdu, Sichuan 610219, China; zsclyb2009{at}


This meta-analysis and systematic review investigated the efficacy of bisphosphonates on the incidence of hip fracture (IHF) in patients of different ages with osteoporosis or osteopenia. We searched Web of Science, Embase, the Cochrane Database, and PubMed from inception to January 10, 2021, for trials reporting the effects of bisphosphonates on the IHF. We included only randomized, double-blind, placebo-controlled clinical trials. We pooled data using a random-effects meta-analysis with risk ratios (RRs) and reported 95% CIs. We also used the Cochran Q and I² statistics to assess the heterogeneity in the results of individual studies. The primary endpoints were the total numbers of people in the bisphosphonates and placebo groups and the numbers of IHFs during the follow-up periods. Bisphosphonates reduced the IHF with an overall effect (RR: 0.66; 95% CI: 0.56 to 0.77; zoledronic acid: RR: 0.60; 95% CI: 0.46 to 0.78; risedronate: RR: 0.74; 95% CI: 0.59 to 0.94, and alendronate: RR: 0.61; 95% CI: 0.40 to 0.95). The result of the heterogeneity assessment was I²=0, p=0.97. In all age groups (all ages, ≥55 years old, ≥65 years old), bisphosphonates reduced the IHF. In the ≥55 years old and ≥65 years old age groups, the RR and 95% CI were 0.63 and 0.43 to 0.93, and 0.60 and 0.44 to 0.81, respectively. Bisphosphonate reduced the IHF in the general population and all age groups (≥55 years old and ≥65 years old). Zoledronic acid, risedronate and alendronate reduced the IHF in osteoporosis or osteopenia populations. The association between bisphosphonate and the IHF does not appear to be influenced by age.

  • osteoporosis
  • fractures
  • bone

Data availability statement

All data relevant to the study are included in the article or uploaded as supplemental information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplemental information.

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  • Contributors SZ, CZ, and DD conceived and designed the experiments. SZ, TZ, and JX performed the experiments. SZ, LZ, and WZ analyzed the data. ZY, LJ, and MG contributed reagents/materials/analysis tools. SZ wrote the paper. SZ is the guarantor of the entire study.

  • Funding This study was supported by the project of the Science and Technology Department in Sichuan province (2011FZ0115).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.