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首页> 外文期刊>BMC Musculoskeletal Disorders >Effect of medications on prevention of secondary osteoporotic vertebral compression fracture, non-vertebral fracture, and discontinuation due to adverse events: a meta-analysis of randomized controlled trials
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Effect of medications on prevention of secondary osteoporotic vertebral compression fracture, non-vertebral fracture, and discontinuation due to adverse events: a meta-analysis of randomized controlled trials

机译：药物对预防次级骨质疏松椎体压缩骨折，非椎骨骨折和缺失引起的影响的影响：随机对照试验的荟萃分析

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摘要

Bone loss with aging and menopause increases the risk of fragile vertebral fracture, osteoporotic vertebral compression fracture (OVCF). The fracture causes severe pain, impedes respiratory function, lower the quality of life, and increases the risk of new fractures and deaths. Various medications have been prescribed to prevent a secondary fracture, but few study summarized their effects. Therefore, we investigated their effects on preventing subsequent OVCF via meta-analyses of randomized controlled trials. Electronic databases, including MEDLINE, EMBASE, CENTRAL, and Web of Science were searched for published randomized controlled trials from June 2015 to June 2019. The trials that recruited participants with at least one OVCF were included. We assessed the risk of bias of every study, estimated relative risk ratio of secondary OVCF, non-vertebral fracture, gastrointestinal complaints and discontinuation due to adverse events. Finally, we evaluated the quality of evidence. Forty-one articles were included. Moderate to high quality evidence proved the effectiveness of?zoledronate (Relative Risk, RR:?0.34; 95% CI, 0.17-0.69,?p?=?0.003), alendronate (RR: 0.54; 95% CI: 0.43-0.68; p??0.0001), risedronate (RR: 0.61; 95% CI: 0.51-0.73; p??0.0001), etidronate (RR, 0.50; 95% CI, 0.29-0.87,?p??0.01),?ibandronate (RR: 0.52; 95% CI: 0.38-0.71; p??0.0001), parathyroid hormone (RR: 0.31; 95% CI: 0.23-0.41; p??0.0001),?denosumab?(RR, 0.41; 95% CI, 0.29-0.57;?p??0.0001) and selective estrogen receptor modulators (Raloxifene, RR: 0.58; 95% CI: 0.44-0.76; p??0.0001; Bazedoxifene, RR: 0.66; 95% CI: 0.53-0.82; p?=?0.0002) in preventing secondary fractures. Moderate quality evidence proved romosozumab had better effect than alendronate (Romosozumab vs. alendronate, RR: 0.64; 95% CI: 0.49-0.84; p?=?0.001) and high quality evidence proved that teriparatide had better effect than risedronate (risedronate vs. teriparatide, RR: 1.98; 95% CI: 1.44-2.70; p??0.0001). Zoledronate, alendronate, risedronate, etidronate, ibandronate, parathyroid hormone, denosumab and selective estrogen receptor modulators had significant secondary prevention effects on OVCF. Moderate quality evidence proved romosozumab had better effect than alendronate. High quality evidence proved PTH had better effect than risedronate, but with higher risk of adverse events.
机译：衰老和更年期的骨质损失会增加脆弱椎骨骨折，骨质疏松椎体压缩骨折（OVCF）的风险。骨折引起严重的疼痛，阻碍了呼吸功能，降低了生活质量，增加了新的骨折和死亡的风险。已经规定了各种药物以防止次要骨折，但很少有研究总结了它们的效果。因此，我们研究了通过随机对照试验的荟萃分析预防随后的OVCF的影响。在2015年6月至2019年6月，搜索了来自2015年6月至6月的公布随机对照试验的电子数据库。征聘了至少一个OVCF的试验。我们评估了每项研究偏见的风险，估计继发性OVCF的相对风险比，非椎骨骨折，胃肠道投诉和由于不良事件而停止。最后，我们评估了证据的质量。包括四十一篇文章。中度至高质量的证据证明了Zoledronate的有效性（相对风险，Rr：0.34; 95％CI，0.17-0.69，ΔP？= 0.003），阿仑膦酸盐（RR：0.54; 95％CI; 0.43-0.68; p？<？0.0001），rostronate（Rr：0.61; 95％ci：0.51-0.73; p？<0.0001），etidronate（Rr，0.50; 95％ci，0.29-0.87，Δp？<0.01）， ？IBANDRONATE（RR：0.52; 95％CI：0.38-0.71; P？<？0.0001），甲状旁腺激素（RR：0.31; 95％CI：0.23-0.41; P？<0.0001），？Denosumab？（RR， 0.41; 95％CI，0.29-0.57;Δp≤≤0.000）和选择性雌激素受体调节剂（Raloxifenes，Rr：0.58; 95％Ci：0.44-0.76; p？<0.0001; bazedoxifene，Rr：0.66; 95 ％CI：0.53-0.82; p？= 0.0002）防止二次骨折。据证明，罗米苏达磺酸盐的适度质量证据（RomoSozumab与阿仑膦酸盐，Rr：0.64; 95％Ci：0.49-0.84; p？= 0.001）和高质量证据证明，萜壶酸葡萄酒比红历（Ristronate Vs）的效果更好Teriparatide，Rr：1.98; 95％CI：1.44-2.70; p？<0.0001）。唑龙酸盐，阿仑膦酸盐，碾压，乙酸乙酯，IBANDRONETE，甲状旁腺激素，DENOSUMAB和选择性雌激素受体调节剂对OVCF具有显着的二级预防作用。中等的质量证据证明罗米苏达酶的效果优于阿伦特膦酸盐。高质量的证据证明了PTH的效果比红历更好，但具有更高的不良事件风险。

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