| Summary: | Osteoporosis is a skeletal disorder characterized by compromised bone strength, predisposing patients to an increased risk of fracture. The postmenopausal form of osteoporosis affects more than 1.5 million Canadians, with prevalence increasing from 6% of women aged 50 to 59 years to more than 40% of women aged 80 years and older. Consequences of sustaining a fracture may be serious and include increased risk of subsequent fractures, hospitalization or institutionalization, decreased quality of life, and premature mortality, with a related burden on the health care system. Antiresorptive agents such as oral bisphosphonates are the standard treatment for postmenopausal osteoporosis, in conjunction with non-pharmacologic measures. Other treatment options include an intravenous bisphosphonate (zoledronic acid), a monoclonal antibody (denosumab), a bone-forming agent (teriparatide), and a selective estrogen receptor modulator (raloxifene). This systematic review was undertaken following a request from provincial drug formularies to evaluate the clinical effectiveness and harms of three of these agents, denosumab, raloxifene, and zoledronic acid, in postmenopausal women with osteoporosis. The evidence gathered is expected to clarify uncertainty regarding these agents and to inform policy-making in the population of interest
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