Lin D, Rieder M J
Cochrane Database Syst Rev. 2007 Apr 18(2):CD005645. doi: 10.1002/14651858.CD005645.pub2.
Decreased bone mineral density (BMD) occurs more commonly in patients with HIV than in the general population, making this group more susceptible to fragility fractures. However, bone loss is under-treated in patients with HIV.
To assess the effects of interventions aimed at increasing bone mineral density in HIV-infected adults.
We searched MEDLINE, EMBASE, LILACS, The Cochrane Library, Meeting Abstracts, AIDSTRIALS, ACTIS, Current Controlled Trials, National Institutes of Health Clinical Trials Registry, and CenterWatch (search date July 2006).
Randomised trials comparing any pharmacological or non-pharmacological therapy with placebo, no treatment, or an alternative therapy, with the goal of increasing bone mineral density in adult (age 18 years or over) patients with HIV.
Two reviewers independently assessed trial eligibility and quality, and extracted data. Where data were incomplete or unclear, conflicts were resolved with discussion and/or trial authors were contacted for further details.
Three completed randomised-controlled studies examined the role of alendronate in patients with HIV and osteopenia or osteoporosis. When all three studies were combined, much heterogeneity was seen (p<0.0001), most likely due to different populations and interventions. A sensitivity analysis showed that in two studies without heterogeneity (p=0.11), alendronate, calcium and vitamin D improved lumbar BMD after one year when compared with calcium and vitamin D (weighted mean difference +2.65 95% confidence interval (CI) 0.80, 4.51 percent). However the alendronate group did not have less fragility fractures, relative risk (RR) 1.28 (95% CI 0.20, 8.21), or osteoporosis, RR 0.50 (95% CI 0.24, 1.01). Adverse events were not significantly different between groups, RR 1.28 (95% 0.20, 8.21). One randomised-controlled study done in patients with AIDS wasting found that after three months, testosterone enanthane improved lumbar BMD compared to placebo by +3.70 (95% CI 0.48, 6.92) percent, but progressive resistance training did not improve lumbar BMD (+0.40 95% CI -2.81, 3.61 percent). No group in this study had any adverse effects.
AUTHORS' CONCLUSIONS: The very limited data reviewed showed that bisphosphonate therapy andin those with AIDS wasting syndrome, testosteronemay be safe and possibly effective methods to improve bone mineral density in HIV patients. The available studies are small, of short duration, and not powered to detect changes in WHO categories and fracture rates. Larger studies using bisphosphonates are currently underway. The role of colecalciferol, androgen replacement in women, and growth hormone are also under investigation.
与普通人群相比，HIV患者骨矿物质密度（BMD）降低更为常见，这使得该群体更易发生脆性骨折。然而，HIV患者的骨质流失治疗不足。
评估旨在提高HIV感染成人骨矿物质密度的干预措施的效果。
我们检索了MEDLINE、EMBASE、LILACS、Cochrane图书馆、会议摘要、AIDSTRIALS、ACTIS、当前对照试验、美国国立卫生研究院临床试验注册库和CenterWatch（检索日期为2006年7月）。
比较任何药物或非药物疗法与安慰剂、不治疗或替代疗法的随机试验，目标是提高18岁及以上HIV成年患者的骨矿物质密度。
两名评价者独立评估试验的合格性和质量，并提取数据。若数据不完整或不清楚，则通过讨论解决冲突和/或联系试验作者获取更多细节。
三项完成的随机对照研究探讨了阿仑膦酸钠在HIV合并骨质减少或骨质疏松患者中的作用。当三项研究合并时，观察到很大的异质性（p<0.0001），最可能的原因是人群和干预措施不同。敏感性分析显示，在两项无异质性的研究中（p=0.11），与钙和维生素D相比，阿仑膦酸钠、钙和维生素D在一年后可改善腰椎骨密度（加权平均差+2.65，95%置信区间（CI）0.80，4.51%）。然而，阿仑膦酸钠组的脆性骨折较少，相对危险度（RR）为1.28（95%CI 0.20，8.21），骨质疏松较少，RR为0.50（95%CI 0.24，1.01）。两组间不良事件无显著差异，RR为1.28（95%CI 0.20，8.21）。一项针对艾滋病消瘦患者的随机对照研究发现，三个月后，庚酸睾酮与安慰剂相比可使腰椎骨密度提高+3.70（95%CI 0.48，6.92）%，但渐进性抗阻训练并未改善腰椎骨密度（+0.40，95%CI -2.81，3.61%）。该研究中没有任何一组出现不良反应。
所回顾的非常有限的数据表明，双膦酸盐疗法以及在艾滋病消瘦综合征患者中使用睾酮可能是提高HIV患者骨矿物质密度的安全且可能有效的方法。现有研究规模小、持续时间短，且无足够能力检测WHO分类和骨折率的变化。目前正在进行使用双膦酸盐的更大规模研究。骨化三醇、女性雄激素替代疗法和生长激素的作用也在研究中。
