Dr. Rosen is correct. The study he references (1) was included in our analysis but was not called out in the section on renal insufficiency. This trial reported the effect of risedronate on fractures among participants with varying degrees of renal insufficiency. This study, which combined data from 9 randomized, double-blind, placebo-controlled trials, reported a reduced incidence of vertebral fractures with risedronate compared with placebo in participants with severe, moderate, and mild renal insufficiency.

Although not reported in our paper, we did collect data and calculate pooled estimates for all adverse events reported in all studies reviewed. Details on musculoskeletal and other adverse events can be found in the appendices to the full report (2). We identified between 1 and 3 studies that compared the effect of alendronate, ibandronate, pamidronate, risedronate, and zoledronic acid on myalgias, cramps, or leg pain. Statistically significant risks were observed for ibandronate (2.25 [CI, 1.57 to 3.29]) and zoledronic acid (3.67 [CI, 2.01 to 7.18]) compared with placebo.

As pointed out by Dr. Stock and colleagues, a limitation of our methods is that we did not specifically search for adverse events, but rather collected data on the adverse events that were reported in the context of our defined search strategy. However, data from the MORE trial (3) and the referenced study by Vogel and colleagues (4) are included our analyses.

Regarding questions about the use of previously published meta-analyses, our methods do not describe pooling across meta-analyses because we did not pool across meta-analyses. All meta-analyses relevant to the study questions were sought, and we described pooled estimates from these meta-analyses as reported by the original authors. When no meta-analyses were available, we pooled data if at least 3 studies were available; otherwise, we reported the results of the 1 or 2 studies identified. Also, as stated in the Methods section of our article, the studies included in each of the meta-analyses are enumerated in the complete report.

Dr. Black and colleagues erroneously state that we assigned a ratings of "good efficacy" and "fair efficacy" for the prevention of hip fractures to alendronate and zoledronic acid, respectively. We reported that each of these agents reduced the risk for hip fracture and that the level of evidence to support this assessment was good for alendronate and fair for zoledronic acid. The criteria used to define the level of evidence are detailed in the Methods section of our article. Per these criteria, however, the level of evidence for both alendronate and zoledronic acid is good, and we thank Dr. Black and colleagues for bringing this error to our attention.

With regard to the data reported in the figures for high-risk populations included in the paper and the data reported in the Appendix Figures for populations not described as high-risk, we would point out that these categories are not necessarily mutually exclusive. In addition, some meta-analyses included in this systematic review reported risk estimates for different risk groups that are not mutually exclusive. Such is the case with the meta-analysis (5) by Stevenson and colleagues. The risk estimates from this meta-analysis for high-risk groups are included in the "high-risk" figures; those for other groups are in the "not described as high-risk" group. It is possible that some of the same patients were included in the overlapping risk groups described in the report by Stevenson and colleagues. However, we do not feel that it was inappropriate for the meta-analysis by Stevenson and colleagues or our review to include data from the same patients in the non–mutually exclusive risk groups. This approach simply provides several different ways to look at the data.