Objective:

To compare the relative efficacy and safety of commonly used anti-osteoporotic agents in men with primary osteoporosis through a network meta-analysis, addressing the fragmented evidence in this area.

Key Findings:

• TER and ABA significantly improved FN-BMD compared to placebo (specific statistical results).
• OBP showed significant gains in TH-BMD and was superior to TER (specific statistical results).
• ABA and TER yielded larger gains at the lumbar spine compared to OBP (specific statistical results).
• Safety comparisons for AEs and SAEs were largely imprecise, highlighting the need for cautious interpretation.

Interpretation:

Treatment effects on BMD vary by skeletal site, with ABA and TER being more effective at the lumbar spine, while OBP shows robust improvements at the total hip. The clinical significance of BMD improvements in fracture risk reduction remains uncertain, emphasizing the need for further investigation.

Limitations:

• Limited direct fracture endpoint data in included RCTs, which may affect the reliability of conclusions.
• Imprecision in safety evidence and SUCRA rankings, along with potential biases in the included studies.

Conclusion:

Further high-quality, long-term RCTs focusing on fracture outcomes and drug-specific adverse events are warranted to better inform treatment decisions in male osteoporosis, highlighting the clinical relevance of these findings.