The fracture outcome measured in one 2022 network meta-analysis (Frontiers in Pharmacology, PubMed 35222037) is fracture risk against placebo, not a head-to-head ranking of one drug against another. That review found teriparatide, denosumab, alendronate and raloxifene were each associated with fewer fractures than placebo in people with chronic kidney disease, people on dialysis, or people with a kidney transplant.
Which fracture outcomes were measured?
The review included 17 studies with data from 10,214 patients. It reported two kinds of outcome: fractures, and bone mineral density (BMD) at the spine and the femoral neck. The odds ratios below compare each drug with placebo. An odds ratio under 1 means lower odds of fracture than placebo in those studies.
| Drug | Fracture odds ratio vs placebo (95% CI) | Bone density result in the review |
|---|---|---|
| Teriparatide | 0.19 (0.10 to 0.35) | Ranked highest for vertebral BMD (SUCRA 97.8%) |
| Denosumab | 0.40 (0.27 to 0.58) | Ranked highest for femoral neck BMD (SUCRA 88.3%) |
| Alendronate | 0.61 (0.40 to 0.92) | Not ranked in the abstract |
| Raloxifene | 0.52 (0.41 to 0.67) | Not ranked in the abstract |
The table does not tell you which drug prevents more fractures than another. The confidence intervals overlap, and the review's authors say there is still some uncertainty about the best treatment options in these patients.
Does the review split fractures by spine or hip?
Not in the abstract. It reports fracture risk overall. Bone density is reported separately for the spine (vertebral) and the femoral neck, which is the hip site. If the fracture site matters for your decision, ask your prescriber whether the full paper breaks fracture results down by site.
Who does this comparison apply to?
The population is patients with stage 2 to 5 chronic kidney disease, patients receiving dialysis, and patients with a history of kidney transplantation. Its results are for that group. Do not carry its rankings over to people with normal kidney function, or to postmenopausal women in general, without a clinician's review.
How do route burden and monitoring differ?
The 2022 abstract does not compare how each drug is given, how often, or what monitoring each one needs. It says safety was judged by reported major adverse events, but it gives no safety results. So this review cannot answer those questions. Your prescriber can address them for your situation. For plain-language background on side effects, the NIA article Taking Medicines Safely as You Age describes them as unwanted or unexpected symptoms that can occur when you take medicine.
| Question | What the 2022 abstract reports | What to ask your prescriber |
|---|---|---|
| Route and schedule | Not reported | How is each option given, how often, and what does that mean for my week? |
| Monitoring | Not reported | What tests or visits would I need, and who orders them? |
| Major adverse events | Assessed, but no results in the abstract | Which side effects matter most for my kidney stage or transplant history? |
What does the 2003 article add?
The 2003 article in Therapie, Therapie article on anti-osteoporosis drug guidelines, is about how new drugs are tested. It is not a comparison of current drugs. Its abstract says secondary prevention trials use the number of patients with new fractures as the main measure and should run at least 3 years. It describes bone mass as the main measure in earlier-phase trials. For primary prevention, it says fracture prevention must be shown before bone mass is used as the main measure. It also says long-term tolerability needs long-term studies and postmarketing data.
As of October 15, 2026, this abstract refers to guidelines from the European Agency for the Evaluation of Medicinal Products and to the International Conference on Harmonisation. It does not name a statute or bill. This is information, not legal advice.
How do I compare two osteoporosis medications fairly?
No single medication is the best choice for everyone. Use this checklist before you read any comparison chart, including this one:
- Match the population: kidney disease, dialysis, kidney transplant, or general postmenopausal women.
- Match the fracture site: spine, hip, or any fracture.
- Match the exact drug, not just its class.
- Check whether the comparison is against placebo or head to head.
- Check whether route, monitoring and side effects are reported at all.
Questions to bring to your prescribing visit
- Given my kidney function stage, or my dialysis or transplant history, which of these options fit?
- Is my main concern spine fractures, hip fractures, or fractures in general?
- How is each option given, how often, and what monitoring would I need?
- Which side effects are most important for my situation, and how will we track them?
- What would you check before any change, and which records should be shared with my other doctors?
Bring a written list of your current medicines and supplements so your prescriber can check any option against them. The Medication and Supplement List printable checklist and caregiver medication lists can help you build it. For background on bone density scans and bone remodeling, read Bone Density and Osteoporosis in Aging.
Your next step is a prescribing discussion. Take the tables above and the questions in this guide to your prescriber, and ask which of these options fit your kidney function and fracture history.
By the Senior Safety Desk Editorial Team
This article is for general information purposes only and does not constitute medical advice. Consult your doctor or qualified healthcare provider before making changes to your health routine.