Objectives Osteoporosis is a common musculoskeletal disease. Systematic reviews (SRs) provide the best evidence of effective treatment strategies for clinical practice. However, the validity of the evidence is prone to be undermined by methodological flaws. This cross-sectional study appraised the methodological quality of a representative sample of SRs on osteoporotic treatments.

Method The Cochrane Database of Systematic Reviews, EMBASE, MEDLINE, and PsycINFO were searched for SRs that included at least one meta-analysis on osteoporotic treatments which were published between 2008 and 2019. The methodological quality of the included SRs was evaluated using the validated AMSTAR (A MeaSurement Tool to Assess systematic Reviews) 2 instrument. Associations between bibliographical characteristics and methodological quality were explored using regression analyses.

Results A total of 101 SRs were included and appraised. One (1.0%) SR was of high quality, 3 (3.0%) were of moderate quality, 11 (10.9%) were of low quality, and 86 (85.1%) were of critically low quality. Specifically, 99 (98.0%) SRs did not explain the selection of study designs, 85 (84.2%) did not provide a list of excluded studies and justify the reasons for exclusion, 85 (84.2%) did not report on funding sources among included studies, and 72 (71.3%) did not state explicitly their review methods in an a priori manner and justify any significant deviations from their protocol. Multivariable ordinal regression analysis illustrated that being published after 2017 [adjusted odds ratio (AOR ): 5.48; confidence interval (CI) : 1.12 – 26.89] was associated with higher methodological quality. SRs focusing on pharmacological interventions [AOR: 0.24; CI: 0.06 – 0.96] were associated with lower methodological quality.

Conclusions The methodological quality of SRs on osteoporotic treatments is disappointing. Future SRs in this area should pay attention to explaining the selection of study designs, providing a list for the excluded studies and justifying such exclusions, reporting on the sources of funding among included studies, pre-specifying methodology and justifying any deviations from the protocol.