Lee S-H, Chang S-S, Lee M, Chan R-C, Lee C-C
Department of Rehabilitation and Physical Medicine, Taipei Veteran General Hospital, Taipei, Taiwan.
Osteoporos Int. 2014 Mar;25(3):1131-9. doi: 10.1007/s00198-013-2575-3. Epub 2013 Dec 17.
We aimed to systematically review observational studies evaluating use of bisphosphonates (BPs) and risk of osteonecrosis of jaw (ONJ) or other sites among non-cancer patients.
PubMed, EMBASE, and Cochrane Library were screened from database inception to Dec 2012.
Two reviewers independently identified cohort and case-control studies evaluating the use of oral or intravenous (IV) BPs and the risk of ONJ and extracted the characteristics of the studies and risk estimates. Pooled estimates of odds ratios and 95 % confidence intervals (CI) were derived by random effects meta-analysis. Subgroup analyses were carried according to patients' characteristics and route of BP use.
We identified 12 studies, including 2,652 cases and 1,571,997 controls. Use of BPs was associated with a significantly increased risk of ONJ or ON of other sites [odds ratio (OR) 2.32; 95 % CI 1.38-3.91; I (2) = 91 %]. The summary OR was 2.91 (95 % CI 1.62-5.22; I (2) = 85.9 %) for adjusted studies. Use of BPs were associated with higher risk on ONJ (OR 2.57; 95 % CI 1.37-4.84; I (2) = 92.2 %) than ON of other sites (OR 1.79; 95 % CI 0.71-4.47; I (2) = 83.3 %). Meta-regression analysis did not find design characteristics or outcome definitions to be significant sources of heterogeneity.
The available evidence suggests that use of BPs in cancer patients is associated with a substantial risk for ONJ. Patients receiving IV BP are at highest risk.
我们旨在系统评价观察性研究，以评估双膦酸盐（BPs）的使用与非癌症患者颌骨坏死（ONJ）或其他部位坏死的风险。
检索了从数据库建立至2012年12月的PubMed、EMBASE和Cochrane图书馆。
两名研究者独立识别评估口服或静脉注射（IV）BPs的使用与ONJ风险的队列研究和病例对照研究，并提取研究特征和风险估计值。通过随机效应荟萃分析得出优势比和95%置信区间（CI）的合并估计值。根据患者特征和BP使用途径进行亚组分析。
我们识别出12项研究，包括2652例病例和1571997例对照。使用BPs与ONJ或其他部位坏死的风险显著增加相关[优势比（OR）2.32；95%CI 1.38 - 3.91；I² = 91%]。调整后的研究汇总OR为2.91（95%CI 1.62 - 5.22；I² = 85.9%）。使用BPs与ONJ的较高风险（OR 2.57；95%CI 1.37 - 4.84；I² = 92.2%）相关，高于其他部位坏死（OR 1.79；95%CI 0.71 - 4.47；I² = 83.3%）。Meta回归分析未发现设计特征或结果定义是异质性的重要来源。
现有证据表明，癌症患者使用BPs与ONJ的重大风险相关。接受静脉注射BP的患者风险最高。
