Lee Soyon, Yin Raynold V, Hirpara Hemant, Lee Nancy C, Lee Adrian, Llanos Samantha, Phung Olivia J
School of Pharmacy, University of Connecticut, Storrs, CT, Department of Pharmacy, Hartford Hospital, Hartford, CT.
College of Pharmacy, Western University of Health Sciences, Pomona, CA, and.
Fam Pract. 2015 Jun;32(3):276-81. doi: 10.1093/fampra/cmu088. Epub 2015 Apr 5.
Studies suggest an increasing occurrence of atypical femoral fractures with the use of bisphosphonates.
To examine whether the use of bisphosphonates increases the risk for atypical fractures.
Systematic review and meta-analysis.
Literature search of MEDLINE, Embase and Cochrane CENTRAL (1948-June 2013).
(i) randomized controlled trial or an observational study, (ii) evaluated bisphosphonate therapy versus no treatment and (iii) reported an incidence of subtrochanteric or diaphyseal fracture individually, or a composite of both. Two independent investigators completed study selection, data extraction and validity assessment. The Cochrane Risk of Bias Tool was used to assess the quality of included studies.
Ten (n = 658497) studies were included in the meta-analysis which demonstrated a statistically significant increased risk of subtrochanteric or diaphyseal fracture with bisphosphonate use [adjusted odds ratios (AOR) = 1.99, 95% confidence intervals (CI)= 1.28-3.10] with I (2) = 84.3% (95% CI = 73.5%-89.5%) and Egger P = 0.01. Subtrochanteric fractures showed an AOR = 2.71 (95% CI = 1.86-3.95) with I (2) = 83.6% (95% CI = 64.3%-90.3%) and Egger's P = 2.29. Diaphyseal fractures had an AOR = 2.06 (95% CI = 1.70-2.50), I (2) = 29.7% (95% CI = 0%-73.7%) and Egger's P = 1.22.
Results suggest there is an increased risk for atypical fractures associated with bisphosphonates and raises awareness to the potential complications related with bisphosphonates. These findings warrant the comprehensive evaluation of patients before initiating bisphosphonate therapy and highlights the need for additional medical decision analyses in future studies to compare the benefit over potential harms of bisphosphonate therapy.
研究表明，使用双膦酸盐类药物后非典型股骨骨折的发生率呈上升趋势。
探讨使用双膦酸盐类药物是否会增加非典型骨折的风险。
系统评价与荟萃分析。
检索MEDLINE、Embase和Cochrane CENTRAL（1948年至2013年6月）的文献。
（i）随机对照试验或观察性研究；（ii）评估双膦酸盐治疗与未治疗的情况；（iii）分别报告转子下或骨干骨折的发生率，或两者的综合发生率。两名独立研究人员完成了研究选择、数据提取和有效性评估。使用Cochrane偏倚风险工具评估纳入研究的质量。
10项研究（n = 658497）纳入荟萃分析，结果显示使用双膦酸盐类药物会使转子下或骨干骨折的风险显著增加[调整优势比（AOR）= 1.99，95%置信区间（CI）= 1.28 - 3.10] [I² = 84.3%（95%CI = 73.5% - 89.5%），Egger P = 0.01]。转子下骨折的AOR = 2.71（95%CI = 1.86 - 3.95），I² = 83.6%（95%CI = 64.3% - 90.3%），Egger P = 2.29。骨干骨折的AOR = 2.06（95%CI = 1.70 - 2.50），I² = 29.7%（95%CI = 0% - 73.7%），Egger P = 1.22。
结果表明，双膦酸盐类药物与非典型骨折风险增加有关，并提高了对双膦酸盐类药物相关潜在并发症的认识。这些发现促使在开始双膦酸盐治疗前对患者进行全面评估，并突出了未来研究中进行额外医学决策分析以比较双膦酸盐治疗的益处与潜在危害的必要性。
