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Review of Comparative Effectiveness of Treatments to Prevent Fractures
- Dennis M. Black, PhD;
- Steven Boonen, MD, PhD;
- Pierre Delmas, MD, PhD; and
- Kenneth W. Lyles, MD
- From the University of California, San Francisco, San Francisco, CA 94107; University of Leuven, Leuven B-3000, Belgium; University of Lyon, INSERM Research Unit 831, Lyon 69437, France; and Duke University and Veterans' Affairs Medical Center, Durham, NC 27710.
TO THE EDITOR:
The meta-analysis by MacLean and colleagues (1) is interesting and comprehensive, but we question 1 methodological aspect: the use of previous meta-analyses and their combination with individual trials. The Methods section is unclear as to how previous meta-analyses were chosen or combined, and this may have led to inconsistent results. For example, for alendronate, 2 meta-analyses are listed for patients who are at high risk (defined in Table 1) for hip fracture (Table 4). One meta-analysis includes 2 trials in high-risk patients. The other includes 6 trials: 2 overlap with the first meta-analysis, whereas the other 4 do not meet the authors' high-risk criteria. …
