Comparative gastrointestinal safety of bisphosphonates in primary osteoporosis: a network meta-analysis

Osteoporos Int (2014) 25:1225–1235

This is the first network meta-analysis to assess the comparative GI safety of bisphosphonates for primary osteoporosis. Our results identify zoledronic acid as having the highest probability of having the greatest number of GI adverse events and nausea. Discontinuation due to adverse events may be a more clinically relevant outcome, with the highest probability of greatest occurrence found with etidronate and zoledronic acid. These results question the assumption that annual zoledronic acid will translate into better adherence. Little difference was found between alendronate and risedronate for serious AE. More research into real-world implications of the comparative safety of bisphosphonates is needed.