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Questioning the Accuracy of a Recent Review of Osteoporosis Medications
IN RESPONSE:
The concerns of Ms. Kuhl and colleagues about our article and the report from which it was derived (1) can be grouped into 3 categories: questions about how meta-analysis could find a statistically significant association between a drug and an outcome when none of the individual studies reported a statistically significant association, questions about what outcomes and studies should have been included in the review, and errors of fact.
First, the fact that a meta-analytic pooled result shows a statistically significant association when none of the individual studies themselves did so should not be surprising: Pooling studies to increase the statistical power to find effects is one of the primary rationales for performing meta-analysis. For the risk for upper gastrointestinal perforations, ulcers, and bleeding events associated with ibandronate, we combined gastrointestinal hemorrhage and hemorrhagic gastritis into upper gastrointestinal perforations, ulcers, or bleeding for 1 of the 2 studies in question (2) and combined duodenal ulcer and stomach ulcer into this category for the other study (3). Also, we combined all doses of ibandronate into 1 ibandronate group. The pooled result was a statistically significant association between use of ibandronate and lower risk for upper gastrointestinal perforations, ulcers, and bleeding. …
