The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.
School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.
Bone. 2020 Oct;139:115541. doi: 10.1016/j.bone.2020.115541. Epub 2020 Jul 27.
Systematic reviews (SRs) provide the best evidence on the effectiveness of treatment strategies for osteoporosis. Carefully conducted SRs provide high-quality evidence for supporting decision-making, but the trustworthiness of conclusions can be hampered by limitation in rigor. We aimed to appraise the methodological quality of a representative sample of SRs on osteoporosis treatments in a cross-sectional study.
Cochrane Database of Systematic Reviews, EMBASE, MEDLINE, and PsycINFO were searched for SRs on osteoporotic treatments. AMSTAR (A MeaSurement Tool to Assess systematic Reviews) 2 was used to evaluate methodological quality of SRs. Associations between bibliographical characteristics and methodological quality ratings were explored using multivariate regression analyses.
A total of 101 SRs were appraised. Overall, one (1.0%) was rated "high quality", three (3.0%) were rated "moderate quality", eleven (10.9%) were rated "low quality", and eighty-six (85.1%) were rated "critically low quality". Ninety-nine (98.0%) did not explain study design selection, eighty-five (84.2%) did not provide a list of excluded studies (84.2%), and eighty-five (84.2%) did not report funding sources of included studies. SRs published in 2018 or after were associated with higher overall quality [adjusted odds ratio (AOR): 5.48; 95% confidence interval (CI): 1.12-26.89], while SRs focused on pharmacological interventions were associated with lower overall quality [AOR: 0.24; 95% CI: 0.06-0.96].
The methodological quality of the included SRs is far from satisfactory. Future reviewers must strengthen rigor by improving literature search comprehensiveness, registering and publishing a priori protocols, and optimising study selection and data extraction. Better transparency in reporting conflicts of interest among reviewers, as well as sources of funding among included primary studies, are also needed.
系统评价（SR）为骨质疏松症治疗策略的有效性提供了最佳证据。精心进行的 SR 为支持决策提供了高质量的证据，但由于严谨性的限制，结论的可信度可能会受到阻碍。我们旨在通过横断面研究评估骨质疏松症治疗系统评价的代表性样本的方法学质量。
对 Cochrane 系统评价数据库、EMBASE、MEDLINE 和 PsycINFO 中关于骨质疏松症治疗的 SR 进行检索。使用 AMSTAR（评估系统评价的测量工具）2 评估 SR 的方法学质量。使用多变量回归分析探讨文献特征与方法学质量评分之间的关系。
共评价了 101 项 SR。总体而言，1 项（1.0%）被评为“高质量”，3 项（3.0%）被评为“中等质量”，11 项（10.9%）被评为“低质量”，86 项（85.1%）被评为“极低质量”。99.0%的 SR 未解释研究设计选择，84.2%的 SR 未提供排除研究的清单（84.2%），84.2%的 SR 未报告纳入研究的资金来源。2018 年或之后发表的 SR 与整体质量较高相关[调整后的优势比（AOR）：5.48；95%置信区间（CI）：1.12-26.89]，而专注于药物干预的 SR 与整体质量较低相关[AOR：0.24；95% CI：0.06-0.96]。
纳入的 SR 方法学质量远未达到令人满意的水平。未来的综述者必须通过提高文献检索的全面性、注册和预先发表方案、优化研究选择和数据提取来提高严谨性。还需要更好地提高审稿人之间利益冲突以及纳入的原始研究资金来源的透明度。
