Lock Catherine A, Lecouturier Janet, Mason James M, Dickinson Heather O
Center for Health Services Research, School of Population and Health Sciences, University of Newcastle upon Tyne, 21 Claremont Place, Newcastle upon Tyne, NE2 4AA, UK.
Osteoporos Int. 2006 Jan;17(1):20-8. doi: 10.1007/s00198-005-1942-0. Epub 2005 Jun 1.
The purpose of this study was to evaluate the clinical effectiveness of lifestyle interventions for preventing osteoporotic fractures in people at high risk. Data sources were electronic bibliographic databases, reference lists of systematic reviews, meta-analyses and included trials, registers of trials and conference databases. There was no language restriction. Study selection comprised randomized controlled trials (RCTs), with appropriate comparator groups and at least 8 weeks of follow-up, reporting a fracture endpoint. Two reviewers independently abstracted data on the population, interventions evaluated, trial quality and outcomes of interest: fractures at any site, spinal, hip and wrist fractures. Six RCTs, enrolling over 1,656 participants, met the inclusion criteria. Overall, trials were of uncertain quality. We categorized trials by type of intervention: exercise (n=3), multifactorial interventions (environmental modifications, exercise programs and review of medical conditions, medication and aids) (n=2) and exposure to sunlight (n=1), and used random effects meta-analyses to combine data within these categories. Exercise was associated with a non-significantly lower risk of spinal fractures (RR=0.52, 95% CI=0.17 to 1.60). Multifactorial interventions were associated with a lower risk of hip fracture, which was of borderline statistical significance (RR=0.37, 95% CI=0.13 to 1.03). Exposure to sunlight was associated with a non-significantly lower risk of hip fracture (RR=0.17, 95% CI=0.02 to 1.35). While withdrawals from treatment were poorly reported, there was no indication of adverse effects of treatment. Multifactorial interventions may reduce the risk of hip fractures when delivered by residential care staff and health visitors. More RCTs of higher quality, recording fractures at all sites susceptible to osteoporotic fractures, are necessary to evaluate exercise interventions, exposure to sunlight and the place of lifestyle alongside pharmacological interventions.
本研究的目的是评估生活方式干预对预防高危人群骨质疏松性骨折的临床效果。数据来源为电子文献数据库、系统评价的参考文献列表、荟萃分析及纳入试验、试验注册库和会议数据库。无语言限制。研究选择包括随机对照试验（RCT），有适当的对照组且随访至少8周，报告骨折终点。两名研究者独立提取关于研究人群、评估的干预措施、试验质量及感兴趣结局的数据：任何部位骨折、脊柱骨折、髋部骨折和腕部骨折。六项RCT纳入了1656名以上参与者，符合纳入标准。总体而言，试验质量不确定。我们根据干预类型对试验进行分类：运动（n = 3）、多因素干预（环境改造、运动计划以及医疗状况、药物和辅助器具评估）（n = 2）和阳光照射（n = 1），并使用随机效应荟萃分析合并这些类别中的数据。运动与脊柱骨折风险非显著降低相关（RR = 0.52，95%CI = 0.17至1.60）。多因素干预与髋部骨折风险降低相关，具有边缘统计学意义（RR = 0.37，95%CI = 0.13至1.03）。阳光照射与髋部骨折风险非显著降低相关（RR = 0.17，95%CI = 0.02至1.35）。虽然治疗退出情况报告不佳，但未显示治疗有不良反应。当由居家护理人员和健康访视员实施多因素干预时，可能会降低髋部骨折风险。需要更多高质量的RCT，记录所有易发生骨质疏松性骨折部位的骨折情况，以评估运动干预、阳光照射以及生活方式与药物干预相比的作用。
