绝经后骨质疏松症治疗中椎体骨折预防疗法的疗效与安全性：哪种疗法效果最佳？一项网状Meta分析。
The efficacy and safety of vertebral fracture prevention therapies in post-menopausal osteoporosis treatment: Which therapies work best? a network meta-analysis.
作者信息
Wang G, Sui L, Gai P, Li G, Qi X, Jiang X
机构信息
Department of Joint Surgery, the Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai 264000, Shandong, China.
Department of Joint Surgery, the Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai 264000, Shandong, China
出版信息
Bone Joint Res. 2017 Jul;6(7):452-463. doi: 10.1302/2046-3758.67.BJR-2016-0292.R1.
OBJECTIVES
Osteoporosis has become an increasing concern for older people as it may potentially lead to osteoporotic fractures. This study is designed to assess the efficacy and safety of ten therapies for post-menopausal women using network meta-analysis.
METHODS
We conducted a systematic search in several databases, including PubMed and Embase. A random-effects model was employed and results were assessed by the odds ratio (OR) and corresponding 95% confidence intervals (CI). Furthermore, with respect to each outcome, each intervention was ranked according to the surface under the cumulative ranking curve (SUCRA) value.
RESULTS
With respect to preventing new vertebral fractures (NVF), all ten drugs outperformed placebo, and etidronate proved to be the most effective treatment (OR 0.24, 95% CI 0.14 to 0.39). In addition, zoledronic acid and parathyroid hormone ranked higher compared with the other drugs. With respect to preventing clinical vertebral fractures (CVF), zoledronic acid proved to be the most effective drug (OR = 0.25, 95% CI 0.08 to 0.92), with denosumab as a desirable second option (OR = 0.48, 95% CI 0.22 to 0.96), when both were compared with placebo. As for adverse events (AE) and severe adverse events (SAE), no significant difference was observed. According to SUCRA, etidronate ranked first in preventing CVF; parathyroid hormone and zoledronic acid ranked highly in preventing NVF and CVF. Raloxifene was safe with a high rank in preventing AEs and SAEs though performed unsatisfactorily in efficacy.
CONCLUSIONS
This study suggests that, taking efficacy and safety into account, parathyroid hormone and zoledronic acid had the highest probability of satisfactory performance in preventing osteoporotic fractures. G. Wang, L. Sui, P. Gai, G. Li, X. Qi, X. Jiang. The efficacy and safety of vertebral fracture prevention therapies in post-menopausal osteoporosis treatment: Which therapies work best? a network meta-analysis. 2017;6:452-463. DOI: 10.1302/2046-3758.67.BJR-2016-0292.R1.
目的
骨质疏松症已日益引起老年人的关注，因为它可能会导致骨质疏松性骨折。本研究旨在通过网状Meta分析评估十种疗法对绝经后女性的疗效和安全性。
方法
我们在多个数据库中进行了系统检索，包括PubMed和Embase。采用随机效应模型，并通过比值比（OR）和相应的95%置信区间（CI）评估结果。此外，针对每个结局，根据累积排序曲线下面积（SUCRA）值对每种干预措施进行排序。
结果
在预防新发椎体骨折（NVF）方面，所有十种药物均优于安慰剂，依替膦酸被证明是最有效的治疗方法（OR 0.24，95% CI 0.14至0.39）。此外，唑来膦酸和甲状旁腺激素的排名高于其他药物。在预防临床椎体骨折（CVF）方面，与安慰剂相比，唑来膦酸被证明是最有效的药物（OR = 0.25，95% CI 0.08至0.92），地诺单抗是理想的第二选择（OR = 0.48，95% CI 0.22至0.96）。至于不良事件（AE）和严重不良事件（SAE），未观察到显著差异。根据SUCRA，依替膦酸在预防CVF方面排名第一；甲状旁腺激素和唑来膦酸在预防NVF和CVF方面排名靠前。雷洛昔芬安全，在预防AE和SAE方面排名较高，但疗效不尽人意。
结论
本研究表明，综合考虑疗效和安全性，甲状旁腺激素和唑来膦酸在预防骨质疏松性骨折方面表现令人满意的可能性最高。王G、隋L、盖P、李G、齐X、江X。绝经后骨质疏松症治疗中椎体骨折预防疗法的疗效和安全性：哪种疗法效果最佳？一项网状Meta分析。2017；6：452 - 463。DOI：10.1302/2046 - 3758.67.BJR - 2016 - 0292.R1。
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