合成代谢药物与非双膦酸盐抗吸收药物联合治疗骨质疏松症：一项荟萃分析。

Combination therapy of anabolic and nonbisphosphonates antiresorptive agents for the treatment of osteoporosis: A meta-analysis.

作者信息

Lou Shenghan, Wang Lifan, Wang Yiwen, Jiang Yunduo, Liu Jingwei, Wang Yansong

机构信息

Department of Spine Surgery Department of PEC-CT, The First Affiliated Hospital of Harbin Medical University, No. 23 Youzheng Road, Harbin, Heilongjiang, P.R. China.

出版信息

Medicine (Baltimore). 2017 Dec;96(52):e9534. doi: 10.1097/MD.0000000000009534.

DOI:10.1097/MD.0000000000009534

PMID:29384970

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6392516/

Abstract

BACKGROUND

According to the mechanisms of action, combination therapy of anabolic and antiresorptive agents may produce more effect for the treatment of osteoporosis. However, the combination therapy of anabolic agents and bisphosphonates reports no benefit and even reduced the anabolic effects of anabolic agents. This study aims to assess the effect of combination therapy of anabolic and nonbisphosphonates antiresorptive agents in adults with osteoporosis.

METHODS

Medline, EMBASE, and Cochrane Library were searched from January 1, 1980 to November 1, 2017 for randomized controlled trials (RCTs) of adults with osteoporosis treated in combination therapy of anabolic and nonbisphosphonates antiresorptive agents compared with monotherapy of either agent alone. The primary outcome was the incidence of fractures. The secondary outcomes were the bone mineral density (BMD) changes at lumbar spine and total hip. Continuous outcomes were expressed as standardized mean difference (SMD) and 95% confidence interval (CI), while dichotomous outcomes were expressed as risk ratio (RR) and 95% CI. The meta-analysis was performed using a random-effects model. I statistic (I > 50% as a threshold indicates significant heterogeneity) was used to assess the heterogeneity.

RESULTS

A total of 10 trials with a total of 1042 patients were included. The pooled results showed that the combination therapy demonstrated a significant advantage over a monotherapy in the BMD improvement at the lumbar spine (SMD 1.18; 95% CI, 0.63 to 1.72; I = 93%) and the total hip (SMD 0.89; 95% CI, 0.48 to 1.29; I = 88%) and further reduce the fracture risk (RR, 0.45; 95%CI, 0.21 to 0.94; I = 0%).

CONCLUSIONS

Low-to-moderate-quality evidence shows that the combination therapy of anabolic and nonbisphosphonates antiresorptive agents is superior to monotherapy in improving the BMD and reducing the fracture risk. However, further high methodological quality studies are needed to determine the antifracture efficacy, cost-effectiveness and safety of this strategy of combination therapy.

摘要

背景

根据作用机制，合成代谢药物与抗吸收药物联合治疗可能对骨质疏松症的治疗产生更大效果。然而，合成代谢药物与双膦酸盐联合治疗并无益处，甚至会降低合成代谢药物的合成代谢作用。本研究旨在评估合成代谢药物与非双膦酸盐抗吸收药物联合治疗对成年骨质疏松症患者的效果。

方法

检索1980年1月1日至2017年11月1日期间的Medline、EMBASE和Cochrane图书馆，查找成年骨质疏松症患者接受合成代谢药物与非双膦酸盐抗吸收药物联合治疗与单独使用任一药物单药治疗的随机对照试验（RCT）。主要结局是骨折发生率。次要结局是腰椎和全髋部的骨密度（BMD）变化。连续结局以标准化均数差（SMD）和95%置信区间（CI）表示，二分结局以风险比（RR）和95%CI表示。采用随机效应模型进行荟萃分析。I统计量（以I>50%为阈值表示存在显著异质性）用于评估异质性。

结果

共纳入10项试验，总计1042例患者。汇总结果显示，联合治疗在改善腰椎（SMD 1.18；95%CI，0.63至1.72；I = 93%）和全髋部（SMD 0.89；95%CI，0.48至1.29；I = 88%）的骨密度方面比单药治疗具有显著优势，并进一步降低骨折风险（RR，0.45；95%CI，0.21至0.94；I = 0%）。