In people at high risk of fractures, romosozumab offered the best effects in preventing the risk of fracture. Abaloparatide was most efficacious to reduce the risk of non-vertebral and vertebral fractures.

A Bayesian network meta-analysis was carried out to compare the safety and effectiveness of pharmacological therapies for people suffering from osteoporosis.

Electronic databases like Cochrane Library, PubMed, and Embase were explored for eligible studies.

All fractures including vertebral and non-vertebral fractures were the major endpoints ascertained, while fractures at the hip or peripheral sites, bone mineral density (BMD) at different sites, and possible side effects were the secondary outcomes ascertained. A total of 79 studies and 108797 participants were incorporated in the final quantitative assessment.

Romosozumab (92.1%) was found to be the most efficient agent to minimize risk for all fractures, with the best therapeutic properties for non-vertebral (88.0%) and vertebral (97.2%) fractures. For reducing the hip fracture, romosozumab (92.5%) offered better therapeutic effects.

Alendronate, strontium ranelate, ibandronate, risedronate, and ibandronate were the ideal intervention agents for the improvement of whole-body BMD (100.0%), spine BMD (95.7%), hip BMD (92.4%), femoral neck BMD (86.7%), and trochanter BMD (95.5%), respectively.

Risedronate usage was related to a greater occurrence of dyspepsia and abdominal pain, while  bazedoxifene usage was linked with back pain, nasopharyngitis, and the highest incidence of any upper-gastrointestinal event.

Hence, pharmacological therapies like romosozumab, abaloparatide, alendronate, strontium ranelate, ibandronate, and risedronate are advisable in clinical practice for people at high risk of fractures.