Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minnesota.
Unidad de Conocimiento y Evidencia (CONEVID), Universidad Peruana Cayetano Heredia, Lima, Peru.
J Clin Endocrinol Metab. 2019 May 1;104(5):1623-1630. doi: 10.1210/jc.2019-00192.
Osteoporosis and osteopenia are associated with increased fracture incidence in postmenopausal women. We aimed to determine the comparative effectiveness of various available pharmacological therapies.
We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, ISI Web of Science, and Scopus for randomized controlled trials that enrolled postmenopausal women with primary osteoporosis and evaluated the risk of hip, vertebral, or nonvertebral fractures. A network meta-analysis was conducted using the multivariate random effects method.
We included 107 trials (193,987 postmenopausal women; mean age, 66 years; 55% white; median follow-up, 28 months). A significant reduction in hip fractures was observed with romosozumab, alendronate, zoledronate, risedronate, denosumab, estrogen with progesterone, and calcium in combination with vitamin D. A significant reduction in nonvertebral fractures was observed with abaloparatide, romosozumab, denosumab, teriparatide, alendronate, risedronate, zoledronate, lasofoxifene, tibolone, estrogen with progesterone, and vitamin D. A significant reduction in vertebral fractures was observed with abaloparatide, teriparatide, parathyroid hormone 1-84, romosozumab, strontium ranelate, denosumab, zoledronate, risedronate, alendronate, ibandronate, raloxifene, bazedoxifene, lasofoxifene, estrogen with progesterone, tibolone, and calcitonin. Teriparatide, abaloparatide, denosumab, and romosozumab were associated with the highest relative risk reductions, whereas ibandronate and selective estrogen receptor modulators had lower efficacy. The evidence for the treatment of fractures with vitamin D and calcium remains limited despite numerous large trials.
This network meta-analysis provides comparative effective estimates for the various available treatments to reduce the risk of fragility fractures in postmenopausal women.
骨质疏松症和骨量减少与绝经后妇女骨折发生率增加有关。我们旨在确定各种可用的药物治疗方法的比较效果。
我们检索了 MEDLINE、EMBASE、Cochrane 对照试验中心注册库、ISI Web of Science 和 Scopus，以纳入原发性骨质疏松症的绝经后妇女，并评估髋部、椎体或非椎体骨折的风险。使用多变量随机效应方法进行网络荟萃分析。
我们纳入了 107 项试验（193987 名绝经后妇女；平均年龄 66 岁；55%为白人；中位随访时间 28 个月）。罗莫佐单抗、阿仑膦酸钠、唑来膦酸、利塞膦酸钠、地舒单抗、雌孕激素和钙加维生素 D 可显著降低髋部骨折风险。阿巴洛帕肽、罗莫佐单抗、地舒单抗、特立帕肽、阿仑膦酸钠、利塞膦酸钠、唑来膦酸、拉索昔芬、替勃龙、雌孕激素和维生素 D 可显著降低非椎体骨折风险。阿巴洛帕肽、特立帕肽、甲状旁腺激素 1-84、罗莫佐单抗、雷奈酸锶、地舒单抗、唑来膦酸、利塞膦酸钠、阿仑膦酸钠、伊班膦酸、雷洛昔芬、巴多昔芬、拉索昔芬、雌孕激素、替勃龙和降钙素可显著降低椎体骨折风险。特立帕肽、阿巴洛帕肽、地舒单抗和罗莫佐单抗与最高的相对风险降低相关，而伊班膦酸和选择性雌激素受体调节剂的疗效较低。尽管进行了许多大型试验，但维生素 D 和钙治疗骨折的证据仍然有限。
本网络荟萃分析为降低绝经后妇女脆性骨折风险的各种可用治疗方法提供了比较效果估计。
