Does alendronate enhance survival rates in osteoporosis patients? A meta-analysis of randomized controlled trials

Objectives This systematic review and meta-analysis aims to evaluate whether alendronate therapy improves survival rates in patients with osteoporosis, in addition to its known benefits in reducing fracture risk. Methods A comprehensive literature search was conducted across Embase, Web of Science, Medline, Cochrane Library, and ClinicalTrials.gov to identify randomized, placebo-controlled clinical trials involving alendronate therapy in osteoporosis patients. The primary outcome was overall survival. Data were extracted and analyzed using fixed-effects or random-effects models based on heterogeneity. The quality of evidence was assessed using the GRADE approach, and publication bias was evaluated using funnel plots. Results A total of 13 randomized controlled trials, involving 15,560 participants, were included in the meta-analysis. Alendronate treatment did not significantly improve survival rates in osteoporosis patients (RR, 1.00; 95% CI, 1.00–1.01). Subgroup analyses, including studies focusing on postmenopausal women and trials lasting three years or more, also showed no significant association between alendronate treatment and survival rates. The studies included in this analysis exhibited low heterogeneity, and no significant publication bias was detected. Conclusions The findings of this meta-analysis suggest that alendronate therapy does not enhance survival rates in osteoporosis patients, despite its effectiveness in reducing fracture risk. Therefore, the primary focus of osteoporosis treatment should remain on fracture prevention. PROSPERO registration number: CRD420251034567.