Zhao Sichun, Zhao Wen, Du Dongpeng, Zhang Chunhao, Zhao Tao, Zheng Liwen, Jin Leiming, Gu Minghao, Xu Junfeng, Yang Zhonghua
Department of Orthopedics, Chengdu BOE Hospital, Chengdu, Sichuan, China
Department of Clinical Immunology, The Affiliated Hospital of Northwest University, Xi'an, Shaanxi, China.
J Investig Med. 2022 Mar;70(3):837-843. doi: 10.1136/jim-2021-001961. Epub 2021 Dec 10.
This meta-analysis and systematic review investigated the efficacy of bisphosphonates on the incidence of hip fracture (IHF) in patients of different ages with osteoporosis or osteopenia. We searched Web of Science, Embase, the Cochrane Database, and PubMed from inception to January 10, 2021, for trials reporting the effects of bisphosphonates on the IHF. We included only randomized, double-blind, placebo-controlled clinical trials. We pooled data using a random-effects meta-analysis with risk ratios (RRs) and reported 95% CIs. We also used the Cochran Q and I² statistics to assess the heterogeneity in the results of individual studies. The primary endpoints were the total numbers of people in the bisphosphonates and placebo groups and the numbers of IHFs during the follow-up periods. Bisphosphonates reduced the IHF with an overall effect (RR: 0.66; 95% CI: 0.56 to 0.77; zoledronic acid: RR: 0.60; 95% CI: 0.46 to 0.78; risedronate: RR: 0.74; 95% CI: 0.59 to 0.94, and alendronate: RR: 0.61; 95% CI: 0.40 to 0.95). The result of the heterogeneity assessment was I²=0, p=0.97. In all age groups (all ages, ≥55 years old, ≥65 years old), bisphosphonates reduced the IHF. In the ≥55 years old and ≥65 years old age groups, the RR and 95% CI were 0.63 and 0.43 to 0.93, and 0.60 and 0.44 to 0.81, respectively. Bisphosphonate reduced the IHF in the general population and all age groups (≥55 years old and ≥65 years old). Zoledronic acid, risedronate and alendronate reduced the IHF in osteoporosis or osteopenia populations. The association between bisphosphonate and the IHF does not appear to be influenced by age.
这项荟萃分析和系统评价研究了双膦酸盐类药物对不同年龄骨质疏松症或骨质减少症患者髋部骨折发生率（IHF）的疗效。我们检索了Web of Science、Embase、Cochrane数据库和PubMed，检索时间从建库至2021年1月10日，以查找报告双膦酸盐类药物对IHF影响的试验。我们仅纳入随机、双盲、安慰剂对照的临床试验。我们使用随机效应荟萃分析合并数据，计算风险比（RRs）并报告95%置信区间（CIs）。我们还使用Cochran Q和I²统计量评估各研究结果的异质性。主要终点是双膦酸盐组和安慰剂组的总人数以及随访期间的髋部骨折人数。双膦酸盐类药物降低了髋部骨折发生率，总体效应为（RR：0.66；95%CI：0.56至0.77；唑来膦酸：RR：0.60；95%CI：0.46至0.78；利塞膦酸：RR：0.74；95%CI：0.59至0.94；阿仑膦酸钠：RR：0.61；95%CI：0.40至0.95）。异质性评估结果为I²=0，p=0.97。在所有年龄组（所有年龄、≥55岁、≥65岁）中，双膦酸盐类药物均降低了髋部骨折发生率。在≥55岁和≥65岁年龄组中，RR和95%CI分别为0.63和0.43至0.93，以及0.60和0.44至0.81。双膦酸盐类药物在普通人群和所有年龄组（≥55岁和≥65岁）中均降低了髋部骨折发生率。唑来膦酸、利塞膦酸和阿仑膦酸钠在骨质疏松症或骨质减少症人群中降低了髋部骨折发生率。双膦酸盐类药物与髋部骨折发生率之间的关联似乎不受年龄影响。
