Eight studies of seven original populations were included for review (4,885 participants): five double blind RCTs (2,789 participants) included two of the same population; one open label RCT (1,076 participants); and two open label randomised crossover studies (1,020 participants). One study scored 2 on the Jadad, five scored 3 and two (of the same population) scored 5.
Monthly 150mg ibandronate versus weekly 70mg alendronate (three RCTs): Two RCTs of the same sample (1,733 participants) found no significant differences between monthly 150mg ibandronate versus weekly 70mg alendronate for change in bone mineral density at lumbar spine and total hip after 12 months. One RCT (1,076 participants) found significantly greater compliance (56.6% versus 38.6%, p<0.0001) and fewer drop-outs (19.6% versus 25.3%, p<0.023) with monthly ibandronate plus patient support programme compared to weekly alendronate. Meta-analyses of these studies found no significant differences between monthly 150mg ibandronate and weekly 70mg alendronate for incidence of side effects, gastrointestinal adverse events, withdrawals and withdrawals due to adverse events (two studies, 2,809 participants). There was evidence of significant statistical heterogeneity for adverse events (Ι²=64.2%) and withdrawals (Ι²=74.9%). Two randomised crossover trials (1,020 participants) reported that significantly more patients preferred monthly ibandronate to weekly alendronate (RR 2.42, 95% CI 2.11 to 2.82, p<1x10-8) and that significantly more patients found monthly 150mg ibandronate convenient compared to weekly 70mg alendronate (RR 3.09, 95% CI 2.62 to 3.62, p<1x10-8).
Monthly 150mg ibandronate versus 7.5mg daily ibandronate (one RCT): Monthly 150mg ibandronate resulted in significantly greater increases in femoral neck, total hip and trochanter bone mineral density compared to daily 7.5mg ibandronate at two-year follow-up (one RCT, 803 participants; p<0.05). There were no significant differences between groups for withdrawals and adverse events.
Monthly 150mg ibandronate versus placebo (two RCTs): Monthly ibandronate significantly increased lumbar spine bone mineral density compared to placebo at 12 months (WMD 0.479, 95% CI 0.299 to 1.729; two RCTS, 253 participants).