Celin Mercedes Rodriguez, Simon Jackeline C, Krzak Joseph J, Fial Alissa V, Kruger Karen M, Smith Peter A, Harris Gerald F
Motion Analysis Center, Shriners Hospitals for Children, Chicago, IL, USA.
Orthopaedic and Rehabilitation Engineering Center, Marquette University, Milwaukee, WI, USA.
Curr Osteoporos Rep. 2020 Oct;18(5):486-504. doi: 10.1007/s11914-020-00621-3.
The goal of this systematic review is to analyze the effectiveness of bisphosphonates (BPs) to treat bone pain in children and adolescents who have diseases with skeletal involvement.
We included 24 studies (2 randomized controlled trials, 3 non-randomized controlled trials, 10 non-randomized open-label uncontrolled studies, 8 retrospective studies, and 1 study with design not specified). The majority of included studies assessed pain from a unidimensional approach, with pain intensity the most frequently evaluated dimension. Only 38% of studies used validated tools; visual analogue scale was the most frequently employed. BPs were used to alleviate bone pain in a wide variety of pediatrics conditions such as osteogenesis imperfecta, secondary osteoporosis, osteonecrosis related to chemotherapy, chronic non-bacterial osteitis, idiopathic juvenile osteoporosis, unresectable benign bone tumor, and cancer-related pain. Twenty of the 24 studies reported a positive effect of BPs for alleviating pain in different pathologies, but 58% of the studies were categorized as having high risk of bias. Intravenous BPs are helpful in alleviating bone pain in children and adolescents. It is advised that our results be interpreted with caution due to the heterogeneity of the doses used, duration of treatments, and types of pathologies included. In addition, this review shows the paucity of high-quality evidence in the available literature and further research is needed.
Before the completion of this review, the protocol was registered to PROSPERO (International prospective register of systematic reviews), PROSPERO 2020 ID # CRD42020158316. Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020158316.
本系统评价的目的是分析双膦酸盐（BPs）治疗骨骼受累疾病儿童和青少年骨痛的有效性。
我们纳入了24项研究（2项随机对照试验、3项非随机对照试验、10项非随机开放标签无对照研究、8项回顾性研究和1项设计未明确的研究）。大多数纳入研究采用单维度方法评估疼痛，疼痛强度是最常评估的维度。只有38%的研究使用了经过验证的工具；视觉模拟量表是最常用的。BPs被用于缓解多种儿科疾病中的骨痛，如成骨不全、继发性骨质疏松、化疗相关的骨坏死、慢性非细菌性骨炎、特发性青少年骨质疏松、不可切除的良性骨肿瘤以及癌症相关疼痛。24项研究中有20项报告了BPs对缓解不同病理情况下疼痛的积极作用，但58%的研究被归类为存在高偏倚风险。静脉注射BPs有助于缓解儿童和青少年的骨痛。由于所用剂量、治疗持续时间和所纳入病理类型的异质性，建议谨慎解读我们的结果。此外，本综述表明现有文献中高质量证据匮乏，需要进一步研究。
在本综述完成之前，该方案已在PROSPERO（国际系统评价前瞻性注册库）注册，PROSPERO 2020 ID#CRD42020158316。可从以下网址获取：https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020158316 。
