Qin Hu , Xun Pan , Yaxian Liang , Hongdan Xu , Jinning Gu , Wenting She , Huixu Xie
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引用次数: 0
Abstract
PURPOSE: The purpose of this study was to estimate the benefits and drawbacks of bisphosphonates in the treatment of osteoporosis and osteopenia in middle-aged and elderly individuals.
METHODS: We searched Ovid MEDLINE, Embase, the Web of Science, and Cochrane library databases for randomized clinical trials (RCTs) evaluating the effects of bisphosphonates and performed a network meta-analysis to summarize the direct and indirect evidence on the efficacy and safety of bisphosphonate therapy in middle-aged and elderly individuals with osteoporosis or osteopenia.
RESULTS: A total of 14 RCTs (7,769 patients with osteoporosis or osteopenia, median age, 67 years, median follow-up, 27 months) were included in this network meta-analysis. Of these, 8, 10, 9, and 6 RCTs provided outcomes on bone mineral density changes, clinical fracture rates, vertebral fracture rates, and nonvertebral fracture rates, respectively. Regarding the primary efficacy outcome, there was a 97% probability for alendronate to be the most effective treatment approach for increasing bone mineral density and an 84% probability for zoledronate to be the most effective treatment approach for clinical fractures. Regarding vertebral fractures and safety outcomes, zoledronate showed an odds ratio (OR) of 0.45 (95% confidence intervals [CI], 0.30-0.69) relative to placebo. For nonvertebral fractures, the OR of zoledronate relative to placebo was 0.51 (95% CI 0.29-0.90).
CONCLUSIONS: This study revealed that alendronate was effective in increasing bone mineral density in middle-aged individuals and that zoledronate was a safe treatment option for osteoporosis and osteopenia, conferring a low incidence of fracture. However, further clinical studies are needed to confirm these results.
目的：本研究的目的是评估双膦酸盐治疗中老年人骨质疏松症和骨质减少症的利弊。方法：我们检索了Ovid MEDLINE、Embase、Web of Science和Cochrane图书馆数据库，检索了评估双膦酸盐疗效的随机临床试验（rct），并进行了网络荟萃分析，总结了双膦酸盐治疗骨质疏松症或骨质减少症中老年患者疗效和安全性的直接和间接证据。结果：该网络荟萃分析共纳入14项随机对照试验（7769例骨质疏松或骨质减少患者，中位年龄67岁，中位随访27个月）。其中，分别有8、10、9和6项rct提供了骨密度变化、临床骨折率、椎体骨折率和非椎体骨折率的结果。关于主要疗效结局，阿仑膦酸钠是增加骨密度最有效的治疗方法的概率为97%，唑来膦酸钠是临床骨折最有效的治疗方法的概率为84%。关于椎体骨折和安全性结果，相对于安慰剂，唑来膦酸钠的优势比（OR）为0.45（95%可信区间[CI]， 0.30-0.69）。对于非椎体骨折，唑来膦酸钠相对于安慰剂的OR为0.51 （95% CI 0.29-0.90）。结论：本研究表明，阿仑膦酸钠可有效增加中年人的骨密度，而唑来膦酸钠是治疗骨质疏松症和骨质减少症的安全选择，且骨折发生率低。然而，需要进一步的临床研究来证实这些结果。
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