硝酸盐对骨骼健康的疗效：观察性和随机对照研究的系统评价和荟萃分析。
The Efficacy of Nitrates for Bone Health: A Systematic Review and Meta-Analysis of Observational and Randomized Controlled Studies.
机构信息
Department of Orthopedics, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, The Key Laboratory of Digital Orthopedics of Yunnan Province, Kunming, China.
School of Basic Medical Sciences, Yunnan University of Chinese Medicine, Kunming, China.
出版信息
Front Endocrinol (Lausanne). 2022 Feb 10;13:833932. doi: 10.3389/fendo.2022.833932. eCollection 2022.
BACKGROUND
Although some studies have found that nitrates were beneficial for bone health, the findings are inconsistent. To assess the efficacy of nitrates for bone health, we conducted a meta-analysis.
METHODS
PubMed, EMBASE databases, Cochrane Library for relevant articles published before December 2021 were searched. All observational and randomized controlled studies that reporting bone mineral density (BMD), fractures with nitrates use were included. A meta-analysis was performed to calculate risk ratios (RRs) for fractures, change differences for bone mineral density.
RESULTS
Four cohort studies and two case-control studies examining the association between nitrates use and fractures were identified. The nitrates use was not associated with any fracture risk (RR = 0.97; 95% CI, 0.94-1.01; = 31.5%) and hip fracture (RR = 0.88; 95% CI, 0.76-1.02; = 74.5%). Subgroup analyses revealed no differences in fracture risk, whereas two cohort studies revealed a reduced risk of hip fracture (RR = 0.71, 95% CI, 0.58-0.86, = 0.0%). There were no statistically significant differences in BMD percent changes at lumbar spine (WMD = -0.07, 95% CI,-0.78-0.65; = 0.0%), total hip (WMD = -0.42, 95% CI,-0.88-0.04; = 0.0%), femoral neck (WMD = -0.38, 95% CI,-1.02-0.25; = 0.0%), or total body (WMD = -0.17, 95% CI,-0.51-0.17; = 0.0%) in two randomized controlled trials (RCTs) compared with a placebo. Another two RCTs compared nitrates with alendronate. Nitrates were comparable to alendronate in increasing bone mineral density at lumbar spine (WMD = 0.00, 95% CI,-0.01-0.02; = 0.0%). Besides, the most common adverse effect was headache, contributing to low adherence to therapy.
CONCLUSION
Our meta-analysis showed no association between nitrates use and fractures in observational studies. The results of RCTs on the usage of nitrates and their effects on BMD were inconsistent. High-quality, long-term studies are needed to clarify the efficacy of nitrates for bone health.
背景
虽然一些研究发现硝酸盐有益于骨骼健康，但研究结果并不一致。为了评估硝酸盐对骨骼健康的疗效，我们进行了荟萃分析。
方法
检索了截至 2021 年 12 月之前在 PubMed、EMBASE 数据库和 Cochrane 图书馆中发表的相关文章。纳入了所有报告使用硝酸盐后骨密度（BMD）和骨折情况的观察性研究和随机对照试验。使用荟萃分析计算骨折风险比（RR）和骨密度变化差异。
结果
共纳入了四项队列研究和两项病例对照研究，以评估硝酸盐使用与骨折之间的关联。硝酸盐的使用与任何骨折风险（RR = 0.97；95%CI，0.94-1.01； = 31.5%）和髋部骨折（RR = 0.88；95%CI，0.76-1.02； = 74.5%）无关。亚组分析显示，骨折风险无差异，而两项队列研究显示髋部骨折风险降低（RR = 0.71，95%CI，0.58-0.86， = 0.0%）。在两项随机对照试验（RCT）中，与安慰剂相比，腰椎（WMD = -0.07，95%CI，-0.78-0.65； = 0.0%）、全髋（WMD = -0.42，95%CI，-0.88-0.04； = 0.0%）、股骨颈（WMD = -0.38，95%CI，-1.02-0.25； = 0.0%）和全身体（WMD = -0.17，95%CI，-0.51-0.17； = 0.0%）的 BMD 百分比变化均无统计学差异。另外两项 RCT 比较了硝酸盐与阿仑膦酸钠的疗效。在增加腰椎 BMD 方面，硝酸盐与阿仑膦酸钠相当（WMD = 0.00，95%CI，-0.01-0.02； = 0.0%）。此外，最常见的不良反应是头痛，导致治疗依从性降低。
结论
本荟萃分析显示，观察性研究中硝酸盐的使用与骨折无关。关于硝酸盐使用及其对 BMD 影响的 RCT 结果不一致。需要高质量、长期的研究来阐明硝酸盐对骨骼健康的疗效。
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