A systematic review including 30 studies with a total of 8 981 subjects (with breast cancer, multiple myeloma, prostate cancer and various mixed cancer diagnoses) was abstracted in DARE. A meta-analysis of studies lasting at least 6 months (18 studies, n = 2556 to 3894 in different analyses) found that, compared with placebo, bisphosphonates statistically significantly reduced the risk of vertebral fractures (OR 0.69, 95% CI 0.57 to 0.84, P<0.0001), non-vertebral fractures (OR 0.65, 95% CI 0.54 to 0.79, P<0.0001), combined fractures (OR 0.65, 95% CI 0.55 to 0.78, P<0.0001), radiotherapy (OR 0.67, 95% CI 0.57 to 0.79, P<0.0001) and hypercalcaemia (OR 0.54, 95% CI 0.36 to 0.81, P<0.003). There was no effect on spinal cord compression (0.71, 0.47 to 1.08, P = 0.113) or orthopaedic surgery (0.70, 0.46 to 1.05, P = 0.086), although there was a reduction in orthopaedic surgery in studies lasting more than 1 year (OR 0.59, 95% CI 0.39 to 0.88, P<0.009). Use of bisphosphonates significantly increased time to first skeletal related event but did not increase survival. Subanalyses showed that most evidence supports use of intravenous aminobisphosphonates.
The following decision support rules contain links to this evidence summary: