Yamaguchi Yuta, Morita Takayoshi, Kumanogoh Atsushi
Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine.
Laboratory of Immunopathology, World Premier International Immunology Frontier Research Center.
Rheumatol Adv Pract. 2020 Mar 13;4(1):rkaa008. doi: 10.1093/rap/rkaa008. eCollection 2020.
Prevention of steroidal osteoporosis is an important issue. There is no clear consensus on the impact of anti-RANKL antibody (denosumab) on BMD in patients with glucocorticoid-induced osteoporosis (GIO). In this study, we aimed to evaluate the impact of denosumab on BMD loss in patients with GIO.
A comprehensive systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. PubMed, Web of Science and Google Scholar were used to search for original studies reported about BMD in patients with GIO treated with denosumab. In meta-analysis of BMD, the mean difference in the rate of change from baseline and the 95% CI were calculated using the random effects model. The mean differences in patients treated with denosumab were compared with those in patients treated with bisphosphonates.
Out of 713 studies identified, seven studies met the selection criteria for the meta-analysis. At 6 and 12 months of denosumab therapy, increases in BMD were observed in the lumbar spine (2.99% [95% CI 2.71, 3.28] and 4.59% [95% CI 4.17, 5.01]), total hip (1.34% [95% CI 0.64, 2.04] and 2.16% [95% CI 2.05, 2.27]) and femoral neck (0.12% [95% CI -0.38, 0.62] and 1.55% [95% CI 0.45, 2.65]). Additionally, denosumab resulted in significant increases in BMD in the lumbar spine and femoral neck at 12 months compared with bisphosphonate therapy.
Patients with GIO experienced significant increases in BMD in response to treatment with denosumab that were detected in the lumbar spine, total hip and femoral neck at 12 months.
预防甾体类骨质疏松是一个重要问题。对于抗RANKL抗体（地诺单抗）对糖皮质激素诱导的骨质疏松症（GIO）患者骨密度（BMD）的影响，目前尚无明确共识。在本研究中，我们旨在评估地诺单抗对GIO患者骨密度丢失的影响。
按照系统评价和Meta分析的首选报告项目（PRISMA）指南进行全面的系统评价和Meta分析。使用PubMed、科学网和谷歌学术搜索关于接受地诺单抗治疗的GIO患者骨密度的原始研究报告。在骨密度的Meta分析中，采用随机效应模型计算基线变化率的平均差异和95%置信区间（CI）。将接受地诺单抗治疗的患者与接受双膦酸盐治疗的患者的平均差异进行比较。
在713项已识别的研究中，7项研究符合Meta分析的选择标准。在地诺单抗治疗6个月和12个月时，腰椎骨密度增加（分别为2.99%[95%CI 2.71，3.28]和4.59%[95%CI 4.17，5.01]），全髋骨密度增加（分别为1.34%[95%CI 0.64，2.04]和2.16%[95%CI 2.05，2.27]），股骨颈骨密度增加（分别为0.12%[95%CI -0.38，0.62]和1.55%[95%CI 0.45，2.65]）。此外，与双膦酸盐治疗相比，地诺单抗在12个月时使腰椎和股骨颈的骨密度显著增加。
GIO患者接受地诺单抗治疗后，在12个月时腰椎、全髋和股骨颈的骨密度显著增加。
