School of Medicine, Trinity College Dublin, Dublin, Ireland.
Department of Rheumatology, St. James's Hospital, Dublin, Ireland.
Rheumatol Int. 2020 Sep;40(9):1369-1384. doi: 10.1007/s00296-020-04623-3. Epub 2020 Jun 16.
Axial spondyloarthropathy (axSpA) is associated with an increased prevalence of osteoporosis, but no recommendations exist to guide management. This systematic review and meta-analysis aim to assess the efficacy of pharmacological and non-pharmacological interventions on bone mineral density (BMD) in axSpA. Electronic databases were searched from inception to June 2019 for randomised controlled trials (RCTs) and quasi (q)-RCTs with pharmacological and non-pharmacological interventions. Independent reviewers undertook screening, and risk of bias and quality assessments. Primary outcomes of interest were BMD at spine and hip. Eight studies (two RCTs and six qRCTs) were included (602 participants). Moderate level evidence favoured alendronate over placebo at femoral neck [mean difference (MD) 2.01, 95% CI 0.67 to 3.35], but there was low-level evidence showing no effect at the spine. There was moderate level evidence showing no effect of tumour necrosis factor inhibitors (TNFi) on BMD at total hip (MD - 0.01, 95% CI - 0.06 to 0.04). Very low-level evidence demonstrated no effect of TNFi on spine or femoral neck. Moderate level evidence favoured neridronate over infliximab at the spine (MD 3.26, 95% CI 1.14 to 5.38), but low-level evidence showed no effect at the total hip (MD 2.75, 95% CI - 0.21 to 5.71). There were no eligible studies investigating the efficacy of non-pharmacological interventions. We conditionally recommend alendronate for management of low BMD in axSpA. The balance of evidence does not recommend the use of TNF-inhibitors for treating low BMD. There is a lack of high-quality evidence guiding clinicians treating osteoporosis in axSpA.
中轴型脊柱关节炎（axSpA）与骨质疏松症的患病率增加有关，但目前尚无指导其管理的相关建议。本系统评价和荟萃分析旨在评估药物和非药物干预措施对 axSpA 患者骨密度（BMD）的疗效。从研究开始到 2019 年 6 月，我们在电子数据库中搜索了药物和非药物干预的随机对照试验（RCT）和准随机对照试验（q-RCT）。独立评审员进行了筛选、偏倚风险和质量评估。主要观察指标为脊柱和髋关节的 BMD。共纳入 8 项研究（2 项 RCT 和 6 项 q-RCT）（602 名参与者）。有中度证据表明阿仑膦酸钠优于安慰剂在股骨颈部位[平均差值（MD）2.01，95%置信区间（CI）0.67 至 3.35]，但在脊柱部位证据水平较低，表明没有效果。有中度证据表明肿瘤坏死因子抑制剂（TNFi）对总髋关节 BMD 没有影响（MD -0.01，95%CI -0.06 至 0.04）。极低证据表明 TNFi 对脊柱或股骨颈 BMD 没有影响。有中度证据表明奈立膦酸钠优于英夫利昔单抗在脊柱部位[MD 3.26，95%CI 1.14 至 5.38]，但在总髋关节部位证据水平较低，表明没有效果（MD 2.75，95%CI -0.21 至 5.71）。没有合适的研究来评估非药物干预措施的疗效。我们有条件地推荐阿仑膦酸钠治疗 axSpA 低 BMD。目前证据并不支持使用 TNF 抑制剂治疗低 BMD。缺乏高质量证据指导 axSpA 骨质疏松症患者的临床治疗。
